From the Guidelines
Bilateral pneumonia is primarily caused by bacterial infections, such as Streptococcus pneumoniae, and viral infections, including influenza and SARS-CoV-2, and its treatment should prioritize prompt antibacterial therapy to reduce morbidity and mortality. The causes of bilateral pneumonia can be multifaceted, including:
- Bacterial infections, with Streptococcus pneumoniae being a common cause 1
- Viral infections, such as influenza and SARS-CoV-2
- Fungal infections, although less common
- Aspiration of stomach contents
Treatment options for bilateral pneumonia depend on the underlying cause but typically involve:
- Antibiotics for bacterial pneumonia, such as amoxicillin-clavulanate (875/125 mg twice daily for 5-7 days), azithromycin (500 mg on day 1, then 250 mg daily for 4 days), or levofloxacin (750 mg daily for 5 days) 1
- Supportive care, including rest, adequate hydration (at least 2-3 liters daily), fever control with acetaminophen (up to 1000 mg every 6 hours), and sometimes chest physiotherapy to clear secretions
- Hospitalization may be necessary for severe cases requiring oxygen therapy, intravenous antibiotics, or respiratory support
Prevention strategies are crucial and include:
- Pneumococcal and influenza vaccinations
- Smoking cessation
- Good hand hygiene
It's essential to note that bilateral pneumonia is more serious than unilateral pneumonia due to its potential to cause more significant oxygen deprivation and require more aggressive treatment approaches. The most recent guidelines emphasize the importance of prompt antibacterial therapy for all patients diagnosed with community-acquired pneumonia to reduce morbidity and mortality 1.
From the Research
Causes of B/L Pneumonia
- B/L pneumonia can be caused by bacteria, viruses, or fungi 2
- Community-acquired pneumonia (CAP) is a common cause of B/L pneumonia, with approximately 1.4 million emergency department visits, 740 000 hospitalizations, and 41 000 deaths in the US annually 3
- The most common bacterial causes of CAP include Streptococcus pneumoniae, which is identified in approximately 15% of patients with an identified etiology of the pneumonia 3
- Viruses are also a common cause of CAP, with up to 40% of patients having viruses identified as the likely cause of CAP 3
Treatment Options for B/L Pneumonia
- Empiric antibiotic therapy is recommended for the treatment of CAP, with the choice of antibiotic depending on the severity of the disease and the likelihood of a bacterial infection 3, 4, 5, 6
- For hospitalized patients with suspected bacterial CAP and without risk factors for resistant bacteria, β-lactam/macrolide combination therapy, such as ceftriaxone combined with azithromycin, is recommended for a minimum of 3 days 3
- Levofloxacin monotherapy is also an effective treatment option for CAP, with a clinical success rate of 94.1% in clinically evaluable patients 4
- The use of systemic corticosteroids within 24 hours of development of severe CAP may reduce 28-day mortality 3
- Antiviral therapy, such as oseltamivir, may be necessary for patients with viral CAP, such as influenza or COVID-19 3, 2