What does this research mean for the field?

Adding intravenous methylprednisolone to nebulized budesonide provides no consistent independent clinical benefit in infants with non-severe RSV pneumonia after accounting for antibiotic use. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

The aim is to assess the efficacy of intravenous methylprednisolone combined with nebulized budesonide for infants with RSV pneumonia and the role of bacterial co-infection.

May 19, 2026Open Access

Efficacy of Adding Intravenous Methylprednisolone to Nebulized Budesonide in RSV Pneumonia: Modification by Bacterial Co-Infection – A Retrospective Cohort Study

Key Points

The aim is to assess the efficacy of intravenous methylprednisolone combined with nebulized budesonide for infants with RSV pneumonia and the role of bacterial co-infection.
Retrospective cohort study of 303 infants with RSV pneumonia (≤ 36 months)
Participants were assigned to IV+methylprednisolone + NEB budesonide (n=140) or NEB budesonide alone (n=163)
Primary outcomes included time to symptom relief, pulmonary sign resolution, hospital stay, and adverse events.
Wheezing relief was faster in the IV+NEB group (2.0 days vs 3.0 days, P=0.010)
Subgroup without bacterial co-infection had the fastest symptom relief and hospital stay (2.0 days for wheezing relief)
After adjusting for antibiotics, the benefits of IV+NEB were largely diminished, indicating antibiotics played a critical role.

Abstract

Purpose: To evaluate the efficacy of intravenous methylprednisolone plus nebulized budesonide (IV+NEB CS) versus nebulized budesonide alone (NEB CS) in infants with RSV pneumonia, and to assess the influence of bacterial co-infection. Methods: This retrospective study included 303 patients (≤ 36 months) with RSV pneumonia. Patients were divided into IV+NEB CS (n=140) and NEB CS (n=163) groups, then stratified by bacterial co-infection and antibiotic use. Primary outcomes were time to cough/fever/wheezing relief, disappearance of pulmonary signs, hospital stay, and glucocorticoid-related adverse events. Results: (1) Wheezing relief was faster in the IV+NEB CS group 2.0 (1.5,4.0) vs 3.0 (2.0,4.0) days, P=0.010, but other outcomes did not differ. (2) Subgroup B (IV+NEB CS without bacterial infection) had the shortest median wheezing relief 2.0 (1.0,3.0) days, pulmonary sign resolution 4.0 (3.0,5.0) days, and hospital stay 4.0 (3.0,5.0) days. (3) Antibiotic use was independently associated with shorter symptom relief and discharge (all P< 0.001); after adjusting for antibiotics, the main effect of IV+NEB CS was no longer significant for most outcomes. (4) Antibiotics also reduced CRP levels (P=0.002). (5) Adverse event rates did not differ between groups. Conclusion: In non-severe RSV pneumonia, adding intravenous methylprednisolone to nebulized budesonide provides no consistent independent benefit after accounting for antibiotic use. The apparent faster recovery with combination therapy was largely explained by antibiotics. Routine intravenous corticosteroids are not recommended. When bacterial co-infection is suspected, antibiotics should be prioritized. Keywords: respiratory syncytial virus, corticosteroids, lower respiratory tract infection, infants and toddlers, antibiotics

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