肺炎へのステロイド投与

ステロイドは免疫を抑えることが知られているが、局所投与であれば全身性の免疫を抑制しないため

喘息患者が肺炎を起こした場合は、ステロイドは中止してはいけない。（中止すると喘息が悪化する。）

副鼻腔炎であれば、ステロイド点鼻は副鼻腔炎を改善させる。

　では、全身に投与するとどうなるか？

その答えは以下の通り。良いOutcomeが得られる。

以下は成人の場合。　小児の場合は骨代謝の問題があるため、できるだけ局所投与（吸入）を選んだ方が良いかも知れない。

The Lancet, Volume 377, Issue 9782, Pages 2023 - 2030, 11 June 2011

市中肺炎へのデキサメタゾン追加、入院期間を短縮、オランダ調査

Meijvis SCA et al.Dexamethasone and length of hospital stay in patients with community-acquired pneumonia: a randomised, double-blind, placebo-controlled trial.The Lancet, Early Online Publication, 1 June 2011.

　非免疫不全の市中肺炎成人患者304人を対象に、抗生物質＋デキサメ タゾンの入院期間への影響を無作為化二重盲検プラセボ対照試験で評価。デキサメタゾン群で入院期間が短縮した（中央値6.5日対7.5日）。院内死亡・重 度有害事象リスクに群間差はなかったが、デキサメタゾン群で高血糖発生率が上昇した（44％対23％；P＜0.0001）。

Dexamethasone and length of hospital stay in patients with community-acquired pneumonia: a randomised, double-blind, placebo-controlled trial

Summary

Background

Whether addition of corticosteroids to antibiotic treatment benefits patients with community-acquired pneumonia who are not in intensive care units is unclear. We aimed to assess effect of addition of dexamethasone on length of stay in this group, which might result in earlier resolution of pneumonia through dampening of systemic inflammation.

Methods

In our double-blind, placebo-controlled trial, we randomly assigned adults aged 18 years or older with confirmed community-acquired pneumonia who presented to emergency departments of two teaching hospitals in the Netherlands to receive intravenous dexamethasone (5 mg once a day) or placebo for 4 days from admission. Patients were ineligible if they were immunocompromised, needed immediate transfer to an intensive-care unit, or were already receiving corticosteroids or immunosuppressive drugs. We randomly allocated patients on a one-to-one basis to treatment groups with a computerised randomisation allocation sequence in blocks of 20. The primary outcome was length of hospital stay in all enrolled patients. This study is registered with ClinicalTrials.gov, number NCT00471640.

Findings

Between November, 2007, and September, 2010, we enrolled 304 patients and randomly allocated 153 to the placebo group and 151 to the dexamethasone group. 143 (47%) of 304 enrolled patients had pneumonia of pneumonia severity index class 4—5 (79 [52%] patients in the dexamethasone group and 64 [42%] controls). Median length of stay was 6·5 days (IQR 5·0—9·0) in the dexamethasone group compared with 7·5 days (5·3—11·5) in the placebo group (95% CI of difference in medians 0—2 days; p=0·0480). In-hospital mortality and severe adverse events were infrequent and rates did not differ between groups, although 67 (44%) of 151 patients in the dexamethasone group had hyperglycaemia compared with 35 (23%) of 153 controls (p<0·0001).

Interpretation

Dexamethasone can reduce length of hospital stay when added to antibiotic treatment in non-immunocompromised patients with community-acquired pneumonia.

Funding

None.