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Corticothérapie systémique et pneumopathies communautaires : où en est-on ?

Corticosteroids as adjunctive treatment for community-acquired pneumonia: Where are we?

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Médecine Intensive Réanimation

Résumé

Les pneumopathies aiguës communautaires (PAC) sont fréquentes et exposent dans les formes sévères à une mortalité élevée. Les corticostéroïdes (CTx) pourraient en améliorer le pronostic grâce à leurs propriétés immunomodulatrices et anti-inflammatoires. Quelques essais randomisés ont suggéré qu’un traitement adjuvant par CTx pourrait accélérer la guérison des PAC et diminuer leur durée d’hospitalisation. Plusieurs méta-analyses ont même suggéré une amélioration de la survie dans les formes sévères de PAC, mais elles sont fondées sur un petit nombre d’essais regroupant moins de 400 patients. À ce jour, les CTx ne peuvent donc être recommandés dans le traitement adjuvant des PAC, mais plusieurs essais randomisés sont en cours dont deux en réanimation, qui devraient aider à préciser leur place thérapeutique.

Abstract

Mortality of severe community-acquired pneumonia (CAP) has not declined over time and is between 25 and 30% in sub-groups of patients. Corticosteroids (CTx) could down-regulate pulmonary and systemic inflammation, accelerate clinical resolution and decrease the rate of inflammation-associated systemic complications. Some randomized controlled trials have suggested that CTx could decrease time to clinical stability and length of stay. Recent meta-analyses suggest an increase in severe CAP survival when CTx are added to standard therapy. However they are based on very few trials gathering less than 400 patients. At this time, guidelines do not recommend CTx as part of CAP treatment. However well-powered trials are underway and will hopefully help to answer this question.

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  1. Centre d’Étude des Pathologies Respiratoires–Inserm U1100, université François Rabelais, Tours et service de réanimation polyvalente, hôpital Bretonneau, CHU de Tours, 2, boulevard Tonnellé, F-37044, Tours cedex 9, France

    P. F. Dequin

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Dequin, P.F., pour le réseau TriGGERSep et le groupe CRICS. Corticothérapie systémique et pneumopathies communautaires : où en est-on ?. Méd. Intensive Réa 26, 48–55 (2017). https://doi.org/10.1007/s13546-017-1254-8

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