Is prednisone good for pneumonia?

In this article:

• Does prednisone help with pneumonia?
• How fast does prednisone work for pneumonia?
• Dosage
• Side effects
• Alternatives
• The bottom line

In this article

• Does prednisone help with pneumonia?
• How fast does prednisone work for pneumonia?
• Dosage
• Side effects
• Alternatives
• The bottom line

Prednisone is a corticosteroid prescribed by healthcare providers to treat various medical conditions, such as asthma, allergic reactions, arthritis, inflammatory bowel disease, and adrenal, blood, or bone marrow conditions. It comes in brand-name forms like Deltasone, Prdnicot, PredniSONE Intensol, and Rayos. Prednisone reduces inflammation (redness, heat, pain, swelling), suppresses the immune system, and replaces cortisol. According to medical experts, in rare instances, prednisone may be used to treat severe pneumonia, but the steroid medication comes with many risks. 

Does prednisone help with pneumonia?

Pneumonia is a common lung infection that causes lung air sacs to fill with fluid or pus, making breathing difficult. Symptoms can range from mild to severe, including cough, fever, chills, and trouble breathing. Several causes of pneumonia exist, including bacteria, viruses, fungi, and parasites. If left untreated, pneumonia can lead to more severe and life-threatening conditions, such as respiratory failure, sepsis, septic shock, and multiple organ dysfunction syndrome.

Taher Saifullah, MD, MS, a pain management specialist and the founder of Spine & Pain Institute Los Angeles, says that in certain instances, prednisone may help treat pneumonia. “While it doesn’t cure the infection directly, it helps with the inflammation in the lungs,” he explains. “By reducing lung swelling, prednisone can make breathing easier and relieve some chest discomfort, which can be especially important if pneumonia is causing a lot of inflammation.

According to research, using prednisone as adjunctive corticosteroid therapy may be safe and effective for patients with community-acquired pneumonia (CAP). Researchers from clinical trials suggest that corticosteroids like prednisone can reduce time to clinical stability and length of hospital stay. CAP is one of the most common respiratory infections outside a healthcare facility. The leading causes of CAP are Streptococcus pneumoniae, influenza A, Mycoplasma pneumoniae, and Chlamydophila pneumoniae.

Another research study reviewing randomized controlled trials (RCTs) suggests that corticosteroids like prednisone may reduce pulmonary inflammation in adolescent and adult patients with severe pneumonia, reducing the risk of respiratory failure and, thus, the mortality rate. 

Systematic reviews and meta-analyses suggest that low-dose steroids, such as methylprednisolone, can be effective in treating acute respiratory distress syndrome (ARDS). ARDS occurs when the lungs are severely injured and can’t supply enough oxygen to the body—respiratory infections like pneumonia, COVID-19, and sepsis cause it. ARDS is severe respiratory depression requiring ICU care and a ventilator. 

So, what does prednisone do for pneumonia? According to John Lowe, MD, a physician at Restore Care in Ogden, Utah, the prescription drug imitates a hormone called cortisol, which decreases inflammation and mutes your body’s immune response. “[Prednisone] attaches to glucose corticoid receptors situated in different cells, thereby inhibiting the production of pro-inflammatory cytokines and decreasing the activity of the immune system,” he explains. “This action assists in limiting the degree of the inflammatory response of the body, which eventually gives relief from symptoms such as pain and swelling in several conditions, including pneumonia, which involves severe lung inflammation.”

How fast does prednisone work for pneumonia?

Dr. Saifullah says prednisone starts working in the body within a few hours, but it can take up to 24 hours for people to start feeling relief from pneumonia symptoms. “It can take a couple of days to see the full effect, especially in terms of breathing and reduced lung inflammation,” he says. “Everyone responds a little differently, so some might feel relief sooner, while others take a bit longer.”

Certain factors can influence how quickly corticosteroid therapy works in your system. “Older adults, people with chronic conditions like diabetes or heart disease, and those with weakened immune systems might experience slower results,” Dr. Saifullah says. “People with pre-existing lung conditions like asthma or chronic obstructive pulmonary disease (COPD) might also take a bit longer to feel the full effects, as their lungs are already more inflamed or sensitive.” He adds that your body rate, metabolic rate, and medication response can also play a role.

If you’re taking prednisone for pneumonia, here are some tips for reducing adverse events, according to Dr. Saifullah:

• Take prednisone pills in the morning to reduce the chance of insomnia.
• Take prednisone with food to reduce the risk of stomach upset.
• Avoid taking prednisone with grapefruit or grapefruit juice, as grapefruit can interact with prednisone and affect how it works in your body.
• Follow the instructions on the medication bottle from your healthcare provider and take the full course of medication.
• Prednisone is prescribed in a “burst dose” and stopped abruptly or with a tapered dose schedule. Gradually taper off prednisone under the guidance of your healthcare provider to avoid withdrawal symptoms—especially if you’ve been taking it for more than two weeks.

Please contact your healthcare provider if you have any questions or concerns about using corticosteroids to treat pneumonia. 

Prednisone dosage for pneumonia

Your provider will give you a recommended dosage of prednisone for pneumonia. “The dosage can vary, but for pneumonia, it’s often in the range of 20-60 milligrams (mg) per day, depending on the severity of the inflammation and the individual’s needs,” Dr. Saifullah explains. “Sometimes it’s given in a higher dose at the beginning, then gradually lowered as symptoms improve. Since everyone’s needs are a little different, following the doctor’s specific dosage instructions is key for safety and effectiveness.”

Contact your healthcare provider to get more insights on prednisone dosage for pneumonia.

Potential side effects and complications

Like any medication, there are some possible side effects associated with taking prednisone for pneumonia. 

Here are some of the most common side effects of prednisone:

• Stomach pain
• Nausea
• Vomiting
• Face puffiness
• Facial redness
• Acne
• Unwanted hair growth
• Changes in appetite
• Mood swings
• Sweating 
• Potassium loss
• Hives
• Rash 
• Gastrointestinal bleeding

More serious side effects of prednisone can include some of the following:

• Steroid psychosis (range of psychiatric symptoms that can occur after prolonged use of steroid medications)
• Muscle damage
• Diabetes mellitus
• High blood pressure 
• Infection
• Seizures
• Congestive heart failure
• Bone tissue death
• Severe or life-threatening allergic reactions 

If you’re experiencing any severe side effects of prednisone, please reach out to your healthcare provider as soon as possible for medical care.

There are also potential risks linked to steroid treatment for viral infections like pneumonia. According to Dr. Lowe, in some instances, taking prednisone for pneumonia can cause more harm than good. “The scenario becomes quite different in viral or atypical pneumonia cases because using prednisone might lower the immune response to the virus, which could be detrimental,” he explains. “Since this drug prednisolone reduces the immune response, it has to be given with care, especially in infections, as it reduces the body’s capacity to eliminate the pathogens responsible for pneumonia.” 

Because of this potential risk, Dr. Saifullah says the steroid prednisone is only used when inflammation—not the infection—is suspected of causing severe symptoms. “For example, in COVID-19, doctors may use steroids in certain severe cases to reduce lung inflammation, but they’re avoided for milder cases to avoid suppressing the immune system too much,” he explains.

According to one research study, routine use of corticosteroids is not recommended in the treatment of non-severe CAP, as the potentially harmful adverse effects may outweigh the benefits. Researchers found that patients with severe CAP taking prednisone had an increased risk of recurrent pneumonia, secondary infections, hyperglycemia, new hypertension, and new insulin dependence.

Prednisone alternatives

Prednisone is rarely given to treat pneumonia. If your healthcare provider deems prednisone unsafe for treating pneumonia inflammation, given its adverse effects, they will recommend other treatment options that will be more effective and less harmful to your health.

Below are alternatives for this corticosteroid treatment to manage pneumonia symptoms:

• Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs are a class of drugs that reduce pain, fever, and inflammation. “For people with diabetes, for instance, non-steroidal options like NSAIDs (e.g., ibuprofen) may be better because steroids can raise blood sugar levels,” Dr. Saifullah says.
• Inhaled corticosteroids (ICs): ICs are anti-inflammatory medications available as prescription-only sprays or powders inhaled into the lungs. “Inhaled corticosteroids might be used for people with asthma or COPD since they reduce inflammation directly in the lungs with fewer body-wide side effects,” Dr. Saifullah says.
• Hydrocortisone: Hydrocortisone is another type of corticosteroid that may be a better alternative to prednisone. In one multicenter, randomized controlled trial, researchers discovered that early treatment with hydrocortisone reduced mortality for patients with severe CAP who were ill enough to be in the intensive care unit (ICU). 

Other potential alternatives to prednisone include:

• Other corticosteroids like mycophenolate or azathioprine
• Antifibrotic drugs like pirfenidone or nintedanib
• Antiviral drugs like oseltamivir, zanamivir, or peramivir
• Mechanical ventilation

“The choice of medication depends on each person’s health conditions, medications, and needs,” Dr. Saifullah says.

The bottom line

Prednisone is a prescription medication that can help treat various medical conditions. While it is not a first-line treatment for pneumonia, it may be used as an adjunctive medication to treat the inflammation caused by the lung infection when inflammation is suspected. Given the risks associated with prednisone, a healthcare provider more often prescribes safer alternatives like NSAIDS or ICs. Before starting treatment, consult your healthcare provider for medical advice regarding prednisone for pneumonia.

“In general, prednisone can be an incredibly helpful medication when used correctly, especially for relieving inflammation and making breathing easier in conditions like pneumonia,” Dr. Saifullah says. “Following your doctor’s guidance and monitoring any side effects is the best approach for safe and effective treatment.”