What is the treatment for pneumonia?

From the Guidelines

The primary treatment for bacterial pneumonia is antibiotics, with a recommended short-course duration of 3-5 days for mild cases and 5-8 days for moderate-to-severe cases, as supported by recent studies 1. The choice of antibiotic depends on the severity of the illness, the patient's underlying health conditions, and the likelihood of antibiotic resistance. For outpatients, a macrolide, doxycycline, or fluoroquinolone with enhanced activity against S. pneumoniae is recommended 1. For patients who are hospitalized, a fluoroquinolone alone or an extended-spectrum cephalosporin (cefotaxime or ceftriaxone) plus a macrolide is recommended 1. Some key points to consider when treating pneumonia include:

• Completing the full course of antibiotics as prescribed, even if symptoms improve before finishing the treatment 1
• Using supportive care such as rest, hydration, and over-the-counter pain relievers to manage symptoms
• Seeking immediate medical attention if symptoms worsen or if the patient experiences difficulty breathing, chest pain, persistent high fever, or confusion
• Considering the patient's individual risk factors, such as age, underlying health conditions, and immune status, when determining the treatment approach 1
• Being aware that viral pneumonia, such as that caused by influenza, is not treated with antibiotics, but rather with antiviral medications and supportive care 1

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 for pneumonia includes:

• Levofloxacin for nosocomial pneumonia due to methicillin-susceptible Staphylococcus aureus, Pseudomonas aeruginosa, Serratia marcescens, Escherichia coli, Klebsiella pneumoniae, Haemophilus influenzae, or Streptococcus pneumoniae 2
• Levofloxacin for 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 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 for pneumonia typically involves the use of antibiotics, with the specific type and duration of treatment depending on the severity of the illness and the suspected or confirmed cause of the infection.

• Empirical antibiotic treatment is often used to achieve treatment success in most patients, with first-line antibiotics including beta-lactams 4.
• In cases where the patient is allergic or intolerant to beta-lactams, new fluorochinolones may be used as an alternative 4.
• Macrolides are also useful if an atypical etiology is suspected, such as Mycoplasma pneumoniae, Chlamydophila pneumoniae, or Legionella pneumophila 4, 5.

Duration of Treatment

The duration of treatment for pneumonia is typically around 7 days, although it may be shorter in some cases 4.

• The Infectious Diseases Society of America (IDSA) recommends initial empiric antimicrobial therapy until laboratory results can be obtained to guide more specific therapy 5.
• For inpatients, attempts should be made to cover Legionella and other common pathogenic bacteria, with alternative antibiotics recommended for patients with structural diseases of the lung, penicillin allergy, or suspected aspiration pneumonia 5.

Outpatient Treatment

Up to 80% of adults with pneumonia can be managed as outpatients, with indicators of morbidity and mortality from pneumonia well described 6.

• Clinical features and radiology do not reliably predict the causative agent in adults with pneumonia, thus initial treatment is empirical 6.
• Streptococcus pneumoniae is the most common cause of pneumonia in all studies, and the initial antibiotic treatment should be active against this organism 6.

Severe Pneumonia and Sepsis

Infections in intensive care unit (ICU) patients, such as severe pneumonia or septicemia, must be treated promptly and effectively due to the high mortality rate 7.

• Treatment is empirical and starts before the results of microbiological cultures are known, with the risk factors affecting mortality including severity of illness, virulence of etiologic pathogens, and the use of inappropriate antibiotic therapy 7.
• Combination therapy with an anti-pseudomonal beta-lactam and a fluoroquinolone or an aminoglycoside are recommended for ICU patients with severe pneumonia or septicemia and risk factors such as underlying diseases, antibiotic pretreatment, or mechanical ventilation 7.