Letter to the Editor

Corticosteroids in severe community-acquired pneumonia

Enmanuel A. Leiva-Murillo, MD and Rosanel Amaro-Rodríguez, MD, PhD
Cleveland Clinic Journal of Medicine December 2025, 92 (12) 723-724; DOI: https://doi.org/10.3949/ccjm.92c.12005

To the Editor: We read with great interest the article in the October issue by Dr. Chapa-Rodriguez and colleagues1 in which the authors discussed the available evidence on the use of corticosteroids in severe community-acquired pneumonia (CAP). When they discuss the clinical guidelines on CAP, the authors refer to the American Thoracic Society (ATS) and Infectious Diseases Society of America guideline published in 2019.2 However, a new ATS clinical practice guideline3 was published in July 2025 that includes the use of corticosteroids among its main new features.

The 2025 ATS guideline recommends administering systemic glucocorticoids in hospitalized patients with severe CAP. This recommendation is based on a meta-analysis of 13 randomized controlled trials that showed an overall reduction in mortality in CAP with systemic glucocorticoids (number needed to treat 34). However, the benefit was limited to the subgroup with severe CAP (number needed to treat 17), with no significant effect observed in nonsevere CAP.3

In contrast to the 2019 ATS and the Infectious Diseases Society of America guideline2 and the guidelines from the European Respiratory Society, European Society of Intensive Care Medicine, European Society of Clinical Microbiology and Infectious Diseases, and Latin American Thoracic Association,4 which restricted the use of glucocorticoids to cases of severe CAP with septic shock, the current recommendation broadens their indication.3 In randomized controlled trials, many patients who met criteria for severe CAP did not have septic shock or refractory shock and also benefited from systemic glucocorticoids. Evidence also suggests a potential role for glucocorticoids in reducing progression to shock or the need for vasopressors.5

This update deserves emphasis, as it may inform bedside decision-making in an area of CAP management that has long remained controversial. Adopting these recommendations may improve the prognosis of patients with severe CAP.

REFERENCES

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    3. Ejaz A, et al
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