Adjunctive therapies for community-acquired pneumonia: a systematic review.

Overview

BACKGROUND: 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). METHODS: 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. RESULTS: 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, beta(2)-agonists, inhaled nitric oxide and angiotensin-converting enzyme inhibitors in patients with CAP. CONCLUSIONS: This review outlines the potential usefulness of the numerous adjunctive therapies for CAP and underlines the need for further research in the field.