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Adjunct systemic corticosteroids increased treatment failure in nonasthmatic children with CAP
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Children diagnosed with community-acquired pneumonia who did not have underlying asthma experienced treatment failure associated with adjunct systemic corticosteroid therapy, according to recent study findings.
Lilliam Ambroggio, PhD, MPH, of Cincinnati Children’s Hospital Medical Center, and colleagues evaluated 2,244 children aged 1 to 18 years diagnosed with community-acquired pneumonia (CAP) to determine the association between adjunct systemic corticosteroid therapy and treatment failure among these patients treated with antibiotics. Eighty-nine percent of patients were white and 69% had private insurance, according to data published in the Journal of the Pediatric Infectious Diseases Society.
Treatment failure was defined as respiratory-associated follow-up within 14 days of diagnosis, at which time the participant received a different antibiotic.
Seventy-seven percent of patients had no history of asthma. Adjunct systemic corticosteroid was prescribed in 86 patients (5%), and 49% of those presented with wheezing.
Of 517 patients with a history of asthma, 40% received adjunct systemic corticosteroids and 61% of those 517 patients presented with wheezing.
Macrolide monotherapy was used for treatment of CAP in 59% of patients.
Treatment failure occurred in 5% of patients within 14 days of the initial CAP diagnosis, and two patients without history of asthma were hospitalized.
Compared with patients without history of asthma who did not receive adjunct systemic corticosteroids, patients without history of asthma who received adjunct systemic corticosteroids were twice as likely to have treatment failure.
Three percent of patients with a history of asthma failed treatment, and higher odds of treatment failure were found among patients who were given adjunct systemic corticosteroids compared with those who did not.
“Among children without asthma, adjunct corticosteroid therapy was associated with an increase in treatment failure for CAP; in contrast, there were no statistically significant differences in treatment failure between corticosteroid recipients and nonrecipients with underlying asthma,” the researchers wrote. “Our findings suggest that in children without an underlying condition of asthma, adjunct corticosteroid therapy is not beneficial for CAP and may increase the likelihood of treatment failure.”
Disclosure: The study was funded in part by the National Institute of Allergy and Infectious Diseases, the Robert Wood Johnson Foundation, and the Ruth L. Kirschestein National Research Service Award.
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