Community-acquired pneumonia is a primary cause of hospitalisation, healthcare resource usage, morbidity and mortality. While randomised clinical trials support individual interventions such as adjunctive corticosteroid use, early progressive mobilisation, antibiotic switching and dietary interventions for patients, the effectiveness of a bundled intervention under routine care conditions remains unclear. A recent Australian stepped-wedge, cluster-randomized clinical trial has assessed the length of hospitalisation, mortality, readmission and adverse effects following a bundled intervention which involved prescription of prednisolone 50 mg daily for seven days and switch from parenteral antibiotics to oral antibiotics. Of the 816 patients studied  (mean age, 76 +/- 13 years, 401 patients received the intervention and 415 patients were in a control group. A 90 day follow up showed no statistically significant differences in the length of stay, mortality or readmission between the two groups, but highlighted an increased occurrence of gastrointestinal bleeding for the intervention group (9 cases, 2.2%) compared to the control group (3 cases, 0.7%). The study, which can be viewed here, demonstrates that a bundled intervention including adjunctive corticosteroids was associated with compromised overall efficacy and may actually cause more harm, suggesting success from individual trials may not equate to success in a combination of interventions.

Contributed by Australian Medication Safety Services Associate – Isabella Singh