THe use of macrolides and corticosteroids as immunomodulators in community-acquired pneumonia

Abstract

The mortality rate in community-acquired pneumonia (CAP) has remained high. A single episode of pneumonia has an increased mortality rate across all age groups v. controls. Research continues to find ways to decrease the mortality rate associated with pneumonia. Corticosteroids and macrolides have been shown to influence inflammation; their immunomodulatory effect decreases the production of inflammatory cytokines. Their use in CAP is proposed to improve mortality and morbidity. However, controversy over their use has been evident in several trials. Recent trials have shown that beta lactam antibiotic use without a macrolide is non-inferior and that corticosteroid use only confers a mortality benefit in patients requiring ionotropic support. In one study, corticosteroid use reduced hospital stay by 1 day, but had no effect on mortality. The regular use of macrolides and corticosteroids solely as immunomodulators in CAP cannot be advocated at this stage.