What are the treatment options for pneumonia?

From the Guidelines

The primary treatment for pneumonia typically involves antibiotics, rest, and supportive care, with the choice of antibiotic depending on the severity of the disease and the risk of drug resistance, as outlined in the 2019 American Thoracic Society and Infectious Diseases Society of America guidelines 1.

Treatment Options

For bacterial pneumonia, common antibiotics include:

• β-Lactam (such as ampicillin-sulbactam, cefotaxime, or ceftriaxone) plus a macrolide (such as azithromycin) or a respiratory fluoroquinolone (such as levofloxacin) for non-severe inpatients 1
• β-Lactam plus a macrolide or a fluoroquinolone for severe inpatients, with additional coverage for MRSA and P. aeruginosa if necessary 1 For viral pneumonia, antiviral medications may be prescribed, such as oseltamivir for influenza-related pneumonia.

Supportive Care

Supportive care includes:

• Rest and adequate sleep
• Staying hydrated by drinking plenty of fluids
• Taking over-the-counter pain relievers like acetaminophen for fever and discomfort
• Using a humidifier to ease breathing Severe cases may require hospitalization for intravenous antibiotics, oxygen therapy, or mechanical ventilation, as recommended in the 2016 Infectious Diseases Society of America and American Thoracic Society guidelines for hospital-acquired and ventilator-associated pneumonia 1.

Importance of Completing Treatment

It's crucial to complete the full course of prescribed antibiotics, even if you start feeling better, to prevent antibiotic resistance. Symptoms usually improve within a few days of starting treatment, but full recovery can take weeks. Antibiotics work by killing or inhibiting the growth of bacteria causing the infection, while antivirals interfere with viral replication. Supportive care helps manage symptoms and boosts the body's natural healing processes. The choice of antibiotic should be guided by the most recent and highest-quality evidence, such as the 2019 American Thoracic Society and Infectious Diseases Society of America guidelines 1, to ensure the best possible outcomes in terms of morbidity, mortality, and quality of life.

From the FDA Drug Label

To reduce the development of drug-resistant bacteria and maintain the effectiveness of levofloxacin tablets and other antibacterial drugs, levofloxacin tablets should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria Levofloxacin tablets are indicated for the treatment of adults (≥ 18 years of age) with mild, moderate, and severe infections caused by susceptible isolates of the designated microorganisms in the conditions listed in this section

1. 1 Nosocomial Pneumonia Levofloxacin tablets are indicated for the treatment of nosocomial pneumonia due to methicillin-susceptible Staphylococcus aureus, Pseudomonas aeruginosa, Serratia marcescens, Escherichia coli, Klebsiella pneumoniae, Haemophilus influenzae, or Streptococcus pneumoniae.
2. 2 Community-Acquired Pneumonia: 7 to 14 Day Treatment Regimen Levofloxacin tablets are indicated for the treatment of community-acquired pneumonia due to methicillin-susceptible Staphylococcus aureus, Streptococcus pneumoniae (including multi-drug-resistant Streptococcus pneumoniae [MDRSP]), Haemophilus influenzae, Haemophilus parainfluenzae, Klebsiella pneumoniae, Moraxella catarrhalis, Chlamydophila pneumoniae, Legionella pneumophila, or Mycoplasma pneumoniae Treatment of pneumonia In the treatment of pneumonia, azithromycin has only been shown to be safe and effective in the treatment of community-acquired pneumonia due to Chlamydia pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae or Streptococcus pneumoniae in patients appropriate for oral therapy

The treatment options for pneumonia include:

• Levofloxacin for the treatment of:
  • Nosocomial pneumonia due to methicillin-susceptible Staphylococcus aureus, Pseudomonas aeruginosa, Serratia marcescens, Escherichia coli, Klebsiella pneumoniae, Haemophilus influenzae, or Streptococcus pneumoniae 2
  • Community-acquired pneumonia due to methicillin-susceptible Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, Haemophilus parainfluenzae, Klebsiella pneumoniae, Moraxella catarrhalis, Chlamydophila pneumoniae, Legionella pneumophila, or Mycoplasma pneumoniae 2
• Azithromycin for the treatment of community-acquired pneumonia due to Chlamydia pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, or Streptococcus pneumoniae in patients appropriate for oral therapy 3

From the Research

Treatment Options for Pneumonia

• The treatment of pneumonia can occur either in the community or hospital setting, depending on the clinical status of the patient 4.
• In the community, supportive management includes anti-pyretics, analgesia, and early review by a medical practitioner if there is deterioration or no response to oral antibiotics within 48 hours 4.
• Suitable first-line antibiotics for children under five are penicillin- or cephalosporin-based, and for children over five, macrolides may also be considered 4, 5.
• For adults, the initial antibiotic treatment should be active against Streptococcus pneumoniae, with options including penicillin, amoxycillin, or erythromycin 5.
• In hospitalized patients, the treatment of community-acquired pneumonia (CAP) has traditionally been with intravenous antibiotics, with a focus on empiric therapy based on the most likely pathogens 6.
• For severe pneumonia, combination therapy with an anti-pseudomonal beta-lactam and a fluoroquinolone or an aminoglycoside is recommended to provide the necessary spectrum of activity and prevent the emergence of resistant organisms 7.
• Monotherapy regimens, such as with cefepime, imipenem, meropenem, or piperacillin-tazobactam, may also be effective and are recommended in international guidelines 7.

Hospital-Acquired Pneumonia

• Rapid identification of infected patients and accurate selection of antimicrobial agents for initial treatment of hospital-acquired pneumonia are important clinical goals 8.
• The choice of antimicrobial drugs should be based on the susceptibility pattern of the causative pathogens, and efforts should be made to obtain reliable pulmonary specimens for direct microscopic examination and cultures before new antibiotics are administered 8.
• In the event that specific etiologic agents are identified, the optimal treatment may be selected without resorting to broad-spectrum drugs or risking inappropriate treatment 8.