Outcome of early short course corticosteroid therapy in severe community-acquired pneumonia: a randomised controlled trial

OBJECTIVE: To evaluate the efficacy and safety of adjunctive dexamethasone in children with severe community-acquired pneumonia (CAP). DESIGN: Double-blind, randomised, placebo-controlled trial. SETTING: Tertiary care hospital. PATIENTS: Children aged 2 months to 15 years diagnosed with severe CAP. INTERVENTION: Participants were randomised to receive intravenous dexamethasone or placebo for 5 days, in addition to standard antimicrobial therapy. MAIN OUTCOME MEASURES: The primary outcome was treatment failure at 72 hours. Secondary outcomes included radiographic progression, respiratory failure, need for ventilation, shock, mortality, length of hospital stay, 4-week readmission and inflammatory markers. RESULTS: 132 children were enrolled (66 per group). Treatment failure at 72 hours occurred in 25.8% in the dexamethasone group vs 60.6% in the placebo group (HR 0.32; 95% CI 0.18 to 0.57; p=0.001). Radiographic worsening was significantly lower in the dexamethasone group (22.7% vs 57.6%; OR 0.22; p=0.001), as was progression to respiratory failure (10.6% vs 31.8%; OR 0.25; p=0.004). No significant differences were observed in need for ventilation, development of shock, mortality, hospital stay or readmission rates. While the reduction in erythrocyte sedimentation rate (ESR) from baseline to 72 hours was greater in the dexamethasone group, absolute ESR values at 72 hours did not differ consistently between groups, whereas no significant differences were observed in high-sensitivity C reactive protein, interleukin (IL)-6, IL-8 or IL-10. CONCLUSIONS: Dexamethasone as adjunctive therapy in severe paediatric CAP significantly reduced early treatment failure and systemic inflammation without increasing adverse outcomes. These findings support its consideration in the management of severe CAP in children. TRIAL REGISTRATION NUMBER: CTRI/2021/09/036799.