ABSTRACT
Corticosteroid therapy for oxygen-free coronavirus disease 2019 (COVID-19) is not recommended due to its negative prognostic impact, but the efficacy of corticosteroids when limited to COVID-19 pneumonia is unclear. We aimed to evaluate the efficacy of corticosteroid monotherapy for patients with COVID-19 pneumonia without supplemental oxygen. We retrospectively reviewed patients with oxygen-free COVID-19 pneumonia at our institute between September 2020 and August 2021 and assessed the use of corticosteroids and the timing of initiation. We classified the patients into the following 2 groups: those who were initiated corticosteroids without developing respiratory failure (early steroid group) and those who were not (standard of care [SOC] group). We used inverse probability of treatment weighting (IPW) to balance between the groups. The primary outcome was the incidence of respiratory failure. A total of 144 patient records were reviewed; 63 patients were in the early steroid group and 81 patients were in the SOC group. Of all patients, 14 (22.2%) and 27 (33.3%) patients in the early steroid and SOC group, respectively, required supplemental oxygen (Pâ =â .192). After adjusted by the IPW method, 10 (16.0%) and 32 (40.1%) patients in the early steroid and SOC groups, respectively, required supplemental oxygen (Pâ =â .004). The logistic regression analysis indicated that early corticosteroid use was significantly associated with a decreased incidence of respiratory failure (odds ratio; 0.17, 95% confidence intervals; 0.06-0.46, Pâ <â .001). Corticosteroid monotherapy may suppress the development of exacerbation requiring oxygen supply in patients with oxygen-free COVID-19 pneumonia.
Subject(s)
Adrenal Cortex Hormones , COVID-19 , Respiratory Insufficiency , Humans , Female , Male , Retrospective Studies , COVID-19/complications , Respiratory Insufficiency/drug therapy , Middle Aged , Adrenal Cortex Hormones/therapeutic use , Adrenal Cortex Hormones/administration & dosage , Aged , SARS-CoV-2 , COVID-19 Drug Treatment , Oxygen Inhalation Therapy/methods , Treatment OutcomeABSTRACT
BACKGROUND: Ceftriaxone (CTRX) and ampicillin/sulbactam (ABPC/SBT) are recommended by various guidelines as the first-line antibiotics for community-acquired pneumonia (CAP). However, which of these antibiotics is more effective for treating non-aspiration CAP remains unclear. METHODS: This study was a prospective, single-center, open-label, quasi-randomized controlled trial. Patients with adult CAP without risk for aspiration were allocated to either a CTRX or ABPC/SBT group based on the date of hospital admission. Macrolide was added to patients in each group. The primary outcome was the clinical response in the validated per-protocol (VPP) population at end of treatment (EOT). The secondary outcomes were clinical response during treatment and at end of study (EOS) in the VPP population, and mortality rate at day 30 in the modified intention-to-treat (MITT) population. RESULTS: Of 696 screened patients, 433 patients were excluded and 263 patients were allocated to receive either of the treatments. Males comprised 54% of patients and mean age and PSI were 62.1 ± 19.8 years and 69.3 ± 30.0, respectively, with 124 patients allocated to the CTRX group and 138 patients allocated to the ABPC/SBT group. The clinical effectiveness rate for the VPP population at EOT was 90% in the CTRX and 96% in the ABPC/SBT group (p = 0.072, 95% confidence interval [CI] of risk difference [RD]: - 12.6-0.8%). No significant difference in effectiveness at day 4 was observed between the CTRX and ABPC/SBT groups (p = 0.079, 95%CI of RD: - 12.1-0.4%), but at day 7, ABPC/SBT was significantly more effective than CTRX in the VPP population (p = 0.047, 95%CI of RD: - 13.3--0.4%). No significant difference in late response at EOS was seen between CTRX and ABPC/SBT groups: cure (89 [86%] and 102 [94%]), relapse (5 [5%] and 1 [1%]) and failure (10 [10%] and 5 [5%]; p = 0.053). Deaths within 30 days in MITT population was higher in CTRX group (4 [3%]) than in ABPC/SBT group (0 [0%]) (p = 0.048, 95%CI of RD: 0.1-6.3%). CONCLUSION: No significant difference in effectiveness was found between ABPC/SBT and CTRX at EOT. However, ABPC/SBT might be more effective in the early phase of treatment. TRIAL REGISTRATION: UMIN-CTR, UMIN000037464. Registered 25 July 2019 - Retrospectively registered, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000042262.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Ceftriaxone/therapeutic use , Community-Acquired Infections/drug therapy , Macrolides/therapeutic use , Pneumonia/drug therapy , Adult , Aged , Aged, 80 and over , Ampicillin/therapeutic use , Community-Acquired Infections/mortality , Drug Therapy, Combination , Female , Humans , Injections, Intravenous , Japan , Male , Middle Aged , Pneumonia/mortality , Prospective Studies , Risk Factors , Sulbactam/therapeutic useSubject(s)
Adenocarcinoma of Lung/drug therapy , Antibodies, Monoclonal, Humanized/poisoning , Antineoplastic Agents, Immunological/poisoning , Functional Laterality/drug effects , Lung Neoplasms/drug therapy , Vocal Cord Paralysis/chemically induced , Adenocarcinoma of Lung/pathology , Aged, 80 and over , Humans , Lung Neoplasms/pathology , Male , Treatment OutcomeABSTRACT
No disponible
Subject(s)
Humans , Male , Aged, 80 and over , Rhabdomyolysis/diagnostic imaging , Rhabdomyolysis/drug therapy , Myositis/chemically induced , Adenocarcinoma/diagnostic imaging , Antibodies, Monoclonal/adverse effects , Adenocarcinoma/pathology , Lung Neoplasms/diagnostic imaging , Prostatic Neoplasms/diagnosis , Positron-Emission TomographySubject(s)
Adenocarcinoma of Lung/drug therapy , Antibodies, Monoclonal, Humanized/adverse effects , Antineoplastic Agents, Immunological/adverse effects , Lung Neoplasms/complications , Myositis/chemically induced , Neoplasms, Second Primary/drug therapy , Rhabdomyolysis/chemically induced , Adenocarcinoma , Adenocarcinoma of Lung/complications , Aged, 80 and over , Antibodies, Monoclonal, Humanized/therapeutic use , Antineoplastic Agents, Immunological/therapeutic use , Blepharoptosis/chemically induced , Deglutition Disorders/chemically induced , Humans , Male , Neoplasms, Second Primary/complications , Prednisone/therapeutic use , Prostatic NeoplasmsSubject(s)
Gallium Radioisotopes/pharmacokinetics , Lung/metabolism , Mycobacterium Infections, Nontuberculous/metabolism , Nontuberculous Mycobacteria/metabolism , Aged, 80 and over , Humans , Lung/diagnostic imaging , Male , Mycobacterium Infections, Nontuberculous/diagnostic imaging , Mycobacterium Infections, Nontuberculous/drug therapy , Nontuberculous Mycobacteria/isolation & purification , Radionuclide ImagingABSTRACT
No disponible
Subject(s)
Humans , Male , Aged , Aneurysm, False/complications , Pulmonary Artery , Lung Abscess/complications , Embolization, TherapeuticABSTRACT
No disponible
Subject(s)
Humans , Male , Adult , Aged, 80 and over , Nontuberculous Mycobacteria/pathogenicity , Mycobacterium Infections/epidemiology , Pneumothorax/etiology , Remission, Spontaneous , Respiratory Tract Infections/microbiologyABSTRACT
No disponible
Subject(s)
Humans , Male , Aged , Aged, 80 and over , Pleurodesis/methods , Pneumothorax/therapy , Patient Safety/statistics & numerical data , Glucose/therapeutic use , Sclerosing Solutions/therapeutic useABSTRACT
No disponible