We read with great interest the recent correspondence from Drs. Leiva-Murillo and Amaro-Rodríguez, who rightly point out that the most recent American Thoracic Society (ATS) guideline,1 published in July 2025, recommends systemic glucocorticoids for hospitalized patients with severe community-acquired pneumonia (CAP). The document upholds the recommendation to not give glucocorticoids in cases of nonsevere pneumonia and severe CAP due to influenza. The ATS position change occurred after the submission of our manuscript; however, by accurately noting this development, our colleagues have enriched the ongoing discussion.
We agree that prior guidelines from the ATS and Infectious Diseases Society of America2 and from the European Respiratory Society, European Society of Intensive Care Medicine, European Society of Clinical Microbiology and Infectious Diseases, and Latin American Thoracic Association3 restricted the use of systemic glucocorticoids to cases of severe CAP with septic shock, largely due to the paucity of high-quality data available in 2019.
We welcome the change in the ATS position in this matter and applaud the Society of Critical Care Medicine for spearheading this change in practice with their 2024 focused statement.4
For now, we recommend assessing pneumonia severity using validated tools referenced in our article.5 Future research should aim to better elucidate the C-reactive protein thresholds that define moderate and severe CAP, with current data supporting a cutoff of 204 mg/L.
- Copyright © 2025 The Cleveland Clinic Foundation. All Rights Reserved.
REFERENCES
- 1↵Jones BE, Ramirez JA, Oren E, et al. Diagnosis and management of community-acquired pneumonia. An official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med Published online July 18, 2025. doi:10.1164/rccm.202507-1692ST
- 2↵Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med 2019; 200(7):e45–e67. doi:10.1164/rccm.201908-1581
- 3↵Martin-Loeches I, Torres A, Nagavci B, et al. ERS/ESICM/ESCMID/ALAT guidelines for the management of severe community-acquired pneumonia. Eur Respir J 2023; 61(4):2200735. doi:10.1183/13993003.00735-2022
- 4↵Chaudhuri D, Nei AM, Rochwerg B, et al. 2024 focused update: guidelines on use of corticosteroids in sepsis, acute respiratory distress syndrome, and community-acquired pneumonia. Crit Care Med 2024; 52(5):e219–e233. doi:10.1097/CCM.0000000000006172
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