In Reply: Corticosteroids in severe community-acquired pneumonia

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.

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