Indications for corticosteroids in the treatment of Community-Acquired pneumonia

• Corticosteroids are not recommended, except in cases of severe CAP. • In cases of severe CAP, hydrocortisone hemisuccinate treatment must be rapidly initiated, at a dosage of 200 mg/d. • Hydrocortisone hemisuccinate treatment is of short duration; its exact length depends on patient response. Preceding guidelines on treatment and management of community-acquired pneumonia (CAP) do not endorse systematic use of corticosteroids. The data in the literature show contradictory results; while some have suggested clinical improvement in cases of severe CAP, others have reported no significant benefit. The recent CAPE-COD trial demonstrated a marked reduction of mortality and intubation through early hydrocortisone treatment (200 mg/d). Consequently, the 2025 French guidelines recommend its being used in cases of severe CAP requiring critical care (excluding influenza, myelosuppression, and aspiration pneumonia, which are not considered in the trial), with progressive de-escalation over the course of eight to fourteen days. Since no benefit has seen shown for non-severe CAP, corticosteroid therapy is not recommended in these cases.