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post in: Beauty, Video Date:05 Oct 2017, 18:15 views:2209
Prednisone vs placebo in community-acquired pneumonia, lancet 2015, pubMed abstract, inclusion criteria: Hospital admission with allergy community-acquired pneumonia defined by a new infiltrate on chest radiograph and the presence of 1 of the following: cough, sputum production, dyspnea, temp 100.4F, abnormal breath sounds or rales, WBC. Exclusion criteria: A condition requiring more than.5 mg/kg per day of prednisone equivalent. HIV with CD4 350 cells/mm.
Neutropenia, active TB, baseline characteristics: Median age 74 years, median duration of symptoms - 4 days. Average SaO2 - 94, bacteremia - 11, group 1 (392 patients) - Prednisone 50 mg daily antibiotics.
Group 2 (393 patients) - Placebo antibiotics, most patients started with amoxicillin plus clavulanic acid or ceftriaxone alone.
In patients with clinical suspicion for legionellosis or in those requiring treatment in the intensive care unit, the beta-lactam was combined with clarithromycin. The primary endpoint was time to clinical stability defined as time until stable vital signs for 24 hours.
Stable vital signs were defined as: Temp 100.4F, heart rate 100 bpm, respiratory rate 24 breaths/min. SBP 90 mmHg ( 100 mmHg for patients with hypertension).cincinnati
Mental status back to baseline, oral intake, paO 60 mmHg or pulse oximetry 90 on room air. Primary outcome, group 1 - median 3 days, group 2 - median.4 days. Between group.33, 95CI.15.50,.0001.
Other, average length of stay was one day less in Group 1 than Group 2 (6 vs 7 days).
There was no significant difference in overall mortality (Group 1 - 4, Group 2 - 3,.57). Complications due to pneumonia: Group 1 - 3, Group 2 - 6 (OR.49, 95CI.23.02,.056).
In-hospital hyperglycemia requiring insulin: Group 1 - 19, Group 2 - 11 (OR.96, 95CI.31.93,.0010).