From the Guidelines
Viral pneumonia is typically treated with supportive care and antiviral medications, if indicated. For most cases, treatment involves rest, hydration, and management of symptoms such as fever and cough.
Treatment Options
- For influenza-related pneumonia, oseltamivir (Tamiflu) 75mg orally twice daily for 5 days or zanamivir (Relenza) 10mg inhaled twice daily for 5 days can be used 1.
- For respiratory syncytial virus (RSV) pneumonia, ribavirin (Virazole) may be considered in severe cases, administered via inhalation for 12-18 hours per day for 3-7 days.
- In cases of COVID-19 pneumonia, treatment may involve remdesivir (Veklury) 200mg intravenously on the first day, followed by 100mg intravenously daily for up to 10 days, or other antiviral medications as recommended by current guidelines 1.
Considerations
It's essential to note that the choice of treatment should be individualized based on the specific viral cause, disease severity, and patient factors, and should be guided by a healthcare professional 1. Hospitalization may be necessary for severe cases or those with underlying health conditions.
Antibiotic Use
Empirical coverage for bacterial pathogens is recommended in patients with community-acquired pneumonia without confirmed COVID-19, but is not required in all patients with confirmed COVID-19–related pneumonia 1. However, some studies suggest that oral antibiotics, such as amoxicillin or azithromycin, may be considered in patients with COVID-19 to prevent secondary bacterial infections 1.
From the FDA Drug Label
A randomized, open-label multi-center clinical trial (Study 5773) in adult subjects with confirmed SARS-CoV-2 infection, an SpO2 of ≤94% on room air, and radiological evidence of pneumonia compared 200 subjects who received VEKLURY for 5 days with 197 subjects who received VEKLURY for 10 days A randomized, open-label multi-center clinical trial (Study 5774) of hospitalized adult subjects with confirmed SARS-CoV-2 infection, SpO2 >94% and radiological evidence of pneumonia compared treatment with VEKLURY for 5 days (n=191) and treatment with VEKLURY for 10 days (n=193) with standard of care (n=200)
The diagnosis of viral pneumonia is based on radiological evidence of pneumonia and confirmed SARS-CoV-2 infection. The treatment for viral pneumonia includes:
- Remdesivir (VEKLURY) for 5 days or 10 days, depending on the severity of the disease
- Standard of care, which may include supplemental oxygen and other supportive measures Key considerations for treatment include:
- Severity of disease: Patients with severe COVID-19 may require longer treatment durations or more intensive care
- Oxygen saturation: Patients with SpO2 ≤94% on room air may require supplemental oxygen
- Comorbidities: Patients with underlying health conditions, such as diabetes or hypertension, may require closer monitoring and more aggressive treatment 2
From the Research
Diagnosis of Viral Pneumonia
- Diagnosis of viral pneumonia depends on appropriate viral cultures and acute and convalescent sera for specific antibodies 3
- Rapid diagnostic tests are now available to detect most of the viruses that cause pneumonias 4
- Newer and faster methods of viral culture and viral antigen detection have improved the capability for definitive diagnosis in recent years 5
Treatment of Viral Pneumonia
- Therapy for viral pneumonia is primarily supportive 5
- Anti-viral therapy is available for several respiratory viruses, including ribavirin, amantadine/rimantadine, interferon alpha, and acyclovir 3
- Ribavirin is indicated for respiratory syncytial virus pneumonia in children and ganciclovir sodium (Cytovene) for cytomegalovirus pneumonia in immunocompromised patients 4
- Acyclovir (Zovirax) is indicated for pneumonias due to herpes simplex virus and varicella-zoster virus infections 4
- Combination antiviral therapy may be beneficial for persistent viral shedding and coronavirus disease 2019 symptoms 6
Prevention of Viral Pneumonia
- Preventive measures for influenza virus pneumonia center on limiting exposure of high-risk patients to active cases of influenza, administering annual vaccinations, and providing chemoprophylaxis 5
- Prevention of viral pneumonia will depend upon improved viral immunization practices 3
- Prophylaxis against RSV is effective in preventing complications 5