Severe CAP – Consider Steroids

Steroids for Hospitalized Patients with Community Acquired Pneumonia

By Zach Adams, OSU EM Resident // Edited by Michael Barrie, OSU EM Assistant Professor

Do steroids help improve mortality in Pneumonia? An article in the Annals of Internal Medicine attempted to set the record straight in the meta-analysis Corticosteroid Therapy for Patients Hospitalized With Community-Acquired Pneumonia: A Systematic Review and Meta-analysis

What did they find?

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Cyclobenzaprine does not help!

By Michael Barrie, OSU EM Assistant Professor

A great emergency medicine study in this month’s JAMA: Friedman et. al Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for treating acute low back pain: A randomized clinical trial.” This was a randomized, double-blind controlled trial to see if adding narcotics or cyclobenzaprine to naprosyn helps improve symptoms in patients with lumbar back pain compared to those that received naprosyn plus placebo. They showed there was NO benefit.

Conclusions and Relevance  Among patients with acute, nontraumatic, nonradicular LBP presenting to the ED, adding cyclobenzaprine or oxycodone/acetaminophen to naproxen alone did not improve functional outcomes or pain at 1-week follow-up. These findings do not support use of these additional medications in this setting.

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Steroids for Anaphylaxis, Medical Myth?

Written by Michael Barrie @MikeBarrieMD, OSU EM Assistant Professor

It’s clear that when a patient presents with sudden onset of a rash, wheezing, vomiting and hypotension every emergency physician knows that epinephrine is life saving. But evidence is mounting against the routine administration of steroids in our patients with anaphylaxis.

Should we abandon corticosteroid administration in anaphlaxis? This month’s issue of Annals of Emergency starts that discussion with Grunau et al “Emergency Department Corticosteroid Use for Allergy or Anaphylaxis is Not Associated with Decreased Relapses.”

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