sabine c a meijvis, hans hardeman, hilde h f remmelts, rik heijlingenberg, ger t rijkers, heleen van...
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Sabine C A Meijvis, Hans Hardeman, Hilde H F Remmelts, Rik Heijlingenberg, Ger T Rijkers, Heleen van Velzen-Blad, G Paul Voorn, Ewoudt M W van de
Garde, Henrik Endeman, Jan C Grutters, Willem Jan W Bos, Douwe H Biesma
The Lancet. June 2011. 377: 2023-30.
No sources of funding cited
Presented By:Deepa Patel
Doctor of Pharmacy Candidate, 2012Mercer University COPHS
COMMON CAUSATIVE BACTERIA
Typical S. pneumonia H. influenza M. catarrhalis
Atypical C. pneumoniae L. pneumophilia M. pneumoniae
ANTIBIOTIC THERAPY
Mainstay for treatment of CAP includes broad spectrum antibiotic(s) based on the patient’s risk factors
Doxycycline Macrolides Fluoroquinolones Cephalosporins Clindamycin Beta lactams Vancomycin
Intravenous corticosteroids are frequently used in sepsis/septic shock patients as they are potent inhibitors of inflammation
Previous studies have investigated the role of corticosteroids in community acquired pneumonia, though outcomes with dexamethasone had not been studied
Purpose: Assess the effect of intravenous dexamethasone compared to placebo in length of hospital stay in non-immunocompromised patients admitted to a hospital with community acquired pneumonia
304 patients randomized and blinded 145 in control group ▪ Received placebo once daily for 4 days
151 in experimental group ▪ 5 mg dexamethasone once daily for 4 days
Nov 2007 to September 2010 in the Netherlands
Exclusion criteria: immunocompromised status, need for immediate transfer to ICU, and prior immunosuppressive medications
Secondary outcomes favoring dexamethasone: greater decline in C-reactive protein and interleukin-6, and statistically significant improvement in social functioning at 30 days following discharge when compared to the placebo group.
Use of dexamethasone in addition to antibiotic therapy in patients
hospitalized with community acquired pneumonia decreases length of
hospital stay by 1 day (p=0.048) when compared to placebo
Dexamethasone, along with other corticosteroids plays a role in decreasing inflammation and expediting recovery for patients with CAP
Adverse effects abound with use of this class of medications, including: Hyperglycemia GI perforation Gastric disturbances Superinfections
Therefore, dexamethasone, and other corticosteroid, use should be judicious in the treatment of inpatient CAP, particularly in patients that have numerous comorbidities
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