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Use of Adjunctive Corticosteroids in Severe Adult Non-HIV Pneumocystis carinii Pneumonia FREE TO VIEW

Jaime G. Pareja; Robert Garland; Henry Koziel
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From the Division of Pulmonary and Critical Care Medicine, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston

1998 by the American College of Chest Physicians

Chest. 1998;113(5):1215-1224. doi:10.1378/chest.113.5.1215
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Study objective: To examine the use of adjunctive corticosteroids in cases of severe Pneumocystis carinii pneumonia (PCP) in non-HIV-infected adult patients.

Design: Retrospective review of medical records.

Setting: Tertiary care urban teaching hospital.

Patients: Review identified 31 consecutive histologically confirmed primary cases of adult non-HIV-related PCP. Complete records were available for 30 patients, including 20 male and 10 female patients with a mean age of 58.3±15 years (±SD). Underlying conditions included organ transplantation (n=13), long-term immunosuppressive therapy (n=9), and chemotherapy for malignancy (n=8). All patients had documented PO2 <65 mm Hg or arterial oxygen saturation <90% on room air.

Interventions: Following the identification of P carinii, in addition to trimethoprim-sulfamethoxazole or pentamidine therapy, 16 patients received increased steroids (≥60 mg prednisone daily equivalent; increased high-dose steroid group), whereas 14 patients were maintained on a regimen of low doses (≤30 mg prednisone equivalent daily) or had steroid therapy tapered (low-dose steroid group).

Results: The increased high-dose steroid group demonstrated a shorter required duration for mechanical ventilation (6.3±6 days vs 18.0±21 days; p=0.047), a shorter duration of ICU admission (8.5±7 days vs 15.8±8 days; p=0.025), and a shorter duration of supplemental oxygen use (10.0±4 vs 32.2±33; p=0.05). The hospital duration to discharge for the nine survivors in each group favored the use of corticosteroids (15.4±5 days vs 36.3±33 days; p=0.077). Similar rates were observed for intubation (75% vs 57%; p=0.442) and in-hospital mortality (44% vs 36%; p=0.722).

Conclusions: These preliminary data suggest that high-dose adjunctive corticosteroids may accelerate recovery in cases of severe adult non-HIV PCP.




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