[What role do corticosteroids play in the treatment of community-acquired pneumonia?].

Some of the immediate, medium-term, and long-term complications of acute community-acquired pneumonia are correlated with the degree of inflammation in the initial phase, particularly when it is dysregulated. Among the treatments designed to control this inflammation, corticosteroid therapy has been the most extensively studied. Randomized trials conducted in hospitalized patients have generally shown faster improvement with corticosteroids and prevention of subsequent worsening. In patients admitted to intensive care units, and despite conflicting trial results, meta-analyses conclude - with a low level of evidence - that there is a reduction in one-month mortality without an increase in the incidence of hospital-acquired infections. The incidence of hyperglycemia is increased with corticosteroid therapy and is likely a barrier to their use outside of intensive care units. In influenza, data from observational studies suggest excess mortality and lead to the contraindication of corticosteroids outside of therapeutic trials. In the future, treatment will likely need to be individualized based on clinical and biologic parameters, particularly the inflammatory syndrome and immunological phenotyping.