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Prednisolone ineffective for lower respiratory tract infections

Prednisolone did not reduce symptom severity or duration in patients with acute lower respiratory tract infections and without asthma, according to findings recently published in JAMA.

“Acute lower respiratory tract infection is common and often treated inappropriately in primary care with antibiotics,” Alastair D. Hay, FRCGP, of the Centre for Academic Primary Care at the University of Bristol in England and colleagues wrote. “Corticosteroids are increasingly used but without sufficient evidence.”

Researchers randomly assigned adults with no history of chronic pulmonary disease who had one lower respiratory tract symptom not needing immediate antibiotic treatment and who had not used asthma medication in the past 5 years, and who also had an acute cough into two groups: two 20-mg prednisolone tablets (n = 199) or matched placebo (n = 202) once a day for 5 days.

Primary outcome was length of moderately bad or worse cough (0 to 28 days; minimal clinically important difference, 3.79 days) and mean severity of symptoms on days 2 to 4, ranked from 0 (not affected) to 6 (the worst). Secondary outcomes were duration of abnormal peak flow, antibiotic use, adverse events as well as severity and length of severity of acute lower respiratory tract infection symptoms.

Hay and colleagues found that the median cough duration was 5 days (interquartile range, 3-8 days) in the prednisolone group and 5 days (interquartile range, 3-10 days) in the placebo group (adjusted HR = 1.11; 95% CI, 0.89-1.39; P = .36 at an = .05).

In addition, mean symptom severity was 1.99 points in the prednisolone group and 2.16 points in the placebo group (adjusted difference, 0.2; 95% CI, 0.4 to 0; P = .05 at an = .001). There were no serious adverse events, and no significant treatment effects were observed for duration or severity of other nonserious adverse events, antibiotic use, abnormal peak flow duration, and acute lower respiratory tract infection symptoms.

“With 398 participants, this trial more than doubles the number of patients recruited to primary care trials of corticosteroids for acute lower respiratory tract infection and, to our knowledge, is the first to investigate the effects of oral rather than inhaled steroids,” Hay and colleagues wrote. “The trial also contributes to a growing body of evidence suggesting that systemic and topical corticosteroids have a limited role in the treatment of common infections and their postinfectious complications in primary care.” – by Janel Miller

Disclosure: Hay reports no relevant financial disclosures. Please see the study for a list of the other authors relevant financial disclosures.