Intensive Care Medicine

, Volume 44, Issue 8, pp 1306–1309 | Cite as

Adjuvant therapies in critical care: steroids to treat infectious diseases

  • José Manuel PereiraEmail author
  • Thiago Lisboa
  • José-Artur Paiva
What's New in Intensive Care


Globally, clinicians have avoided prescribing corticosteroids (CS) for active infection, as they have immunosuppressive effects and therefore may impair mechanisms that fight infection. However, we, as intensivists, often see patients adequately treated with antibiotics deteriorating on the basis of progressive, localized or systemic inflammation triggered by an infection that is being treated with an adequate antibiotic regimen. Clinically, they have been proven as deleterious in some infectious diseases, such as influenza pneumonia, established for early use in a wide range of infective conditions, such as pneumococcal meningitis, and remain a matter of intense debate in several other infectious conditions, such as severe community-acquired pneumonia.

We present a synthesis of the role of corticosteroids in severe infectious situations treated in intensive care departments, discussing, as the title implies, infectious diseases and not syndromic presentations, such as...


Compliance with ethical standards

Conflicts of interest

José Manuel Pereira: received honoraria for lectures from MSD, Astellas, Pfizer and Novartis. Thiago Lisboa: no conflicts of interest. José Artur Paiva: no conflicts of interest.


  1. 1.
    Confalonieri M, Urbino R, Potena A et al (2005) Hydrocortisone infusion for severe community-acquired pneumonia: a preliminary randomized study. Am J Respir Crit Care Med 171:242–248CrossRefPubMedGoogle Scholar
  2. 2.
    Garcia-Vidal C, Calbo E, Pascual V et al (2007) Effects of systemic steroids in patients with severe community-acquired pneumonia. Eur Respir J 30:951–956CrossRefPubMedGoogle Scholar
  3. 3.
    Nie W, Zhang Y, Cheng J, Xiu Q (2012) Corticosteroids in the treatment of community-acquired pneumonia in adults: a meta-analysis. PLoS One 7:e47926CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Torres A, Sibila O, Ferrer M et al (2015) Effect of corticosteroids on treatment failure among hospitalized patients with severe community-acquired pneumonia and high inflammatory response: a randomized clinical trial. JAMA 313:677–686CrossRefPubMedGoogle Scholar
  5. 5.
    Tagami T, Matsui H, Horiguchi H et al (2015) Low-dose corticosteroid use and mortality in severe community-acquired pneumonia patients. Eur Respir J 45:463–472CrossRefPubMedGoogle Scholar
  6. 6.
    Siemieniuk RA, Meade MO, Alonso-Coello P et al (2015) Corticosteroid therapy for patients hospitalized with community-acquired pneumonia: a systematic review and meta-analysis. Ann Intern Med 163:519–528CrossRefPubMedGoogle Scholar
  7. 7.
    Marti C, Grosgurin O, Harbarth S et al (2015) Adjunctive corticotherapy for community acquired pneumonia: a systematic review and meta-analysis. PLoS One 10:e0144032CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Horita N, Otsuka T, Haranaga S et al (2015) Adjunctive systemic corticosteroids for hospitalized community-acquired pneumonia: systematic review and meta-analysis 2015 update. Sci Rep 5:14061CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Chen LP, Chen JH, Chen Y et al (2015) Efficacy and safety of glucocorticoids in the treatment of community-acquired pneumonia: a meta-analysis of randomized controlled trials. World J Emerg Med 6:172–178CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Wan YD, Sun TW, Liu ZQ et al (2016) Efficacy and safety of corticosteroids for community-acquired pneumonia: a systematic review and meta-analysis. Chest 149:209–219CrossRefPubMedGoogle Scholar
  11. 11.
    Briel M, Spoorenberg SMC, Snijders D et al (2017) Corticosteroids in patients hospitalized with community-acquired pneumonia: systematic review and individual patient data meta-analysis. Clin Infect Dis. CrossRefGoogle Scholar
  12. 12.
    Pastores SM, Annane D, Rochwerg B, The Corticosteroid Guideline Task Force of SCCM and ESICM (2017) Guidelines for the diagnosis of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part II): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017. Intensive Care Med. CrossRefPubMedGoogle Scholar
  13. 13.
    Rodrigo C, Leonardi-Bee J, Nguyen-Van-Tam J, Lim WS (2016) Corticosteroids as adjunctive therapy in the treatment of influenza. Cochrane Database Syst Rev. PubMedCrossRefGoogle Scholar
  14. 14.
    Cooley L, Dendle C, Wolf J et al (2014) Consensus guidelines for diagnosis, prophylaxis and management of Pneumocystis jirovecii pneumonia in patients with haematological and solid malignancies. Intern Med J 44(12b):1350–1363CrossRefPubMedGoogle Scholar
  15. 15.
    Lemiale V, Debrumetz A, Delannoy et al (2013) Adjunctive steroid in HIV-negative patients with severe Pneumocystis pneumonia. Respir Res 14:87CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Hoffman SL, Punjabi NH, Kumala S et al (1984) Reduction of mortality in chloramphenicol-treated severe typhoid fever by high-dose dexamethasone. N Engl J Med 310(2):82–88CrossRefPubMedGoogle Scholar
  17. 17.
    Rogerson SJ, Spooner VJ, Smith TA, Richens J (1991) Hydrocortisone in chloramphenicol-treated severe typhoid fever in Papua New Guinea. Trans R Soc Trop Med Hyg 85:113–116CrossRefPubMedGoogle Scholar
  18. 18.
    Brouwer MC, McIntyre P, Prasad K, van de Beek D (2015) Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev. CrossRefPubMedGoogle Scholar
  19. 19.
    van de Beek D, Cabellos C, Dzupova O et al (2016) ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clin Microbiol Infect 22(Suppl 3):S37–S62CrossRefPubMedGoogle Scholar
  20. 20.
    de Gans J, van de Beek D, European Dexamethasone in Adulthood Bacterial Meningitis Study Investigators (2002) Dexamethasone in adults with bacterial meningitis. N Engl J Med 347(20):1549–1556CrossRefPubMedGoogle Scholar
  21. 21.
    Prasad K, Singh MB, Ryan H (2016) Corticosteroids for managing tuberculous meningitis. Cochrane Database Syst Rev. PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    Wiysonge CS, Ntsekhe M, Thabane L et al (2017) Interventions for treating tuberculous pericarditis. Cochrane Database Syst Rev. CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Ryan H, Yoo J, Darsini P (2017) Corticosteroids for tuberculous pleurisy. Cochrane Database Syst Rev. PubMedCentralCrossRefPubMedGoogle Scholar
  24. 24.
    Sharma SK, Mohan A, Sharma A, Mitra DK (2005) Miliary tuberculosis: new insights into an old disease. Lancet Infect Dis 5(7):415–430CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2017

Authors and Affiliations

  • José Manuel Pereira
    • 1
    • 2
    • 3
    Email author
  • Thiago Lisboa
    • 4
    • 5
  • José-Artur Paiva
    • 1
    • 2
    • 3
  1. 1.Emergency and Intensive Care DepartmentCentro Hospitalar S. JoãoPortoPortugal
  2. 2.Department of MedicineUniversity of Porto Medical SchoolPortoPortugal
  3. 3.Grupo de Infecçao e SepsisPortoPortugal
  4. 4.Critical Care Department and Infection Control CommitteeHospital de Clinicas de Porto AlegrePorto AlegreBrazil
  5. 5.Rede Institucional de Pesquisa e Inovacao em Medicina Intensiva, Complexo Hospitalar Santa Casa de Porto AlegrePorto AlegreBrazil

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