Adjunctive therapies for community-acquired pneumonia: a systematic review

Abstract

We endeavoured to accumulate and evaluate the available evidence regarding therapies that have been investigated as potential adjuncts to antimicrobials for the treatment of immunocompetent adult patients with bacterial community-acquired pneumonia (CAP). PubMed, Cochrane Central Register of Controlled Trials and of Systematic Reviews, and bibliographies of relevant articles were searched. A meta-analysis was performed whenever applicable. Administration of corticosteroids in patients with severe CAP was associated with lower mortality compared with placebo (odds ratio 0.21, 95% confidence interval 0.05–0.83). There was no evidence suggesting a survival benefit by the administration of activated protein C, non-invasive mechanical ventilation, anticoagulants, immunoglobulin, granulocyte-colony-stimulating factor, statins, probiotics, chest physiotherapy, antiplatelet drugs, over-the-counter cough medications, β₂-agonists, inhaled nitric oxide and angiotensin-converting enzyme inhibitors in patients with CAP. This review outlines the potential usefulness of the numerous adjunctive therapies for CAP and underlines the need for further research in the field.