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CC March 2016 Community acquired pneumonia (CAP) and steroids

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echoecho's version from 2016-06-03 23:49

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Question Answer
List the four symptoms of CAP?Fever, chills, pleuritic chest pain, mucopurulent sputum
List the four etiologies of CAP?S. Pneumonia do, M. Pneumonia, Legionella species, respiratory viruses
List four validated severity prediction rules?Pneumonia severity index, CURB-65, severe community-acquired pneumonia score, SMART-COP
*** These prediction rules help determine what?Which patients require hospitalization and which require admission to ICU
What medication has been studied as adjunct to antibiotics because of the inflammatory response to CAP?Systemic corticosteroids
Did studies on inpatients differentiate the etiologic agents (bacteria vs viral)No
A 2010 study randomized patients to Prednisolone 40 mg or placebo and found what regarding length of stay and cure rates or 30 day mortality?1) no difference in length of stay. 2) no difference in cure rates at 7 and 14 days. 3) no difference in 30 day mortality
What was the result of a 2011 study of inpatients with CAP randomized to receive Dexamethadone 5 mg daily for 4 days or placebo?Length of stay decreased by 1 day in the treatment group
What were the result of the 2012 study regarding steroid use in CAP?Found no benefit to steroid use and harmful effects (hyperglycemia, superinfection so and longer lengths of stay)
What were the results of a 2013 study regarding steroid use in CAP?Found moderate quality evidence suggesting that adjunct steroid therapy reduces length of stay but does not alter mortality
Discuss the 2 studies in 2015 regarding steroid use in CAP?1) prednisone 50 mg or placebo for 5 days and the time to clinical stability was shortened in the treatment group without increase in complications. 2) randomized patients with severe CAP and a high inflammatory response (CRP >150 mg/L) to receive methylprednisolone or placebo for 5 days. Results showed lower treatment failure rate were seen with steroid use. Hyperglycemia often requiring insulin therapy, was more likely in the steroid treated groups
Why are there any major organizations that recommend guidelines recommending steroid use as adjunct therapy in CAP?because of inconsistent results, partly due to differences in patient populations (age, color iritis) and steroid protocols
*** in 2014, a meta-analysis found what results regarding adjunct steroid therapy?1) reduced hospital length of stay. 2) decreased time to clinical stability. 3) lower rates of mechanical ventilation. 4) lower rates of acute respiratory distress syndrome
Why was it not possible to determine formulation, dose or duration of therapy?because of the varied treatment regimens used
Do any recommendations exist regarding selection of patients for steroid therapy based on severity and inflammatory markers?no
So the decision to use steroids should be made on a case-to-case basis, true of false?true
Can patients with underlying conditions (COPD) benefit from steroids?yes
*** SUMMARY = Study results are inconsistent regarding the benefit of corticosteroids in CAP, although a 2015 meta analysis found what four benefits of use of adjunct steroid therapy in CAP?1) reduced hospital length of stay. 2) decreased time to clinical stability 3) lower rates of mechanical ventilation. 4) lower rates of acute respiratory distress syndrome
*** SUMMARY = No recommendations exist regarding the selection of patients for steroid therapy based on severity or inflammatory markers, so the decision to use steroids is made how?on a case to case basis
*** SUMMARY = Do patients with underlying conditions benefit from steroids (COPD)?yes
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