Which corticosteroid should be used in severe pneumonia?

Dear Editor,

We have read with interest the article on optimising the diagnostic and therapeutic approach to pneumonia, published in a recent issue of your journal.¹ Among the authors’ final recommendations was to use corticosteroids in patients with community-acquired pneumonia and septic shock, as well as in those who require admission to the ICU, provided that influenza has been ruled out as the cause. More specifically, they suggest the use of methylprednisolone at a dose of 0.5&#¿;mg/kg/12&#¿;h. The authors add that this adjuvant treatment should be started early (first 24&#¿;h) and maintained for no more than 5–7 days. We are surprised by the recommendation to use methylprednisolone instead of hydrocortisone. While methylprednisolone has not shown a benefit in terms of survival,² hydrocortisone did show benefit in one of the clinical trials that the authors themselves include in their work.³