What is the treatment for pneumonia?

From the Guidelines

The treatment for pneumonia should be guided by the severity of the disease and the suspected or confirmed causative pathogen, with antibiotics being the primary treatment for bacterial pneumonia, as recommended by the most recent guidelines 1.

Treatment Approach

The approach to treating pneumonia involves:

• Identifying the causative agent, whether bacterial, viral, or fungal, to guide specific therapy.
• Assessing the severity of the disease to determine the need for hospitalization or outpatient treatment.
• Selecting appropriate antibiotics for bacterial pneumonia, such as amoxicillin, azithromycin, or doxycycline, based on susceptibility patterns and patient factors 1.
• Using antivirals for viral pneumonia, like oseltamivir for influenza-related pneumonia.
• Providing supportive care, including rest, hydration, fever control, and humidification, to alleviate symptoms and support recovery.

Antibiotic Selection

For bacterial pneumonia, the choice of antibiotic depends on the suspected or confirmed pathogen and its antibiotic susceptibility pattern.

• For pneumococcal pneumonia, penicillin-sensitive strains can be treated with penicillin G or amoxicillin, while penicillin-resistant strains may require cefotaxime, ceftriaxone, or a respiratory fluoroquinolone 1.
• For legionnaires’ disease, azithromycin or a fluoroquinolone is preferred 1.
• Empiric therapy for hospitalized patients may include a β-lactam plus a macrolide or a respiratory fluoroquinolone alone, depending on the severity of illness and local resistance patterns 1.

Supportive Care

Supportive care is crucial for all patients with pneumonia and includes:

• Rest to reduce oxygen demand.
• Adequate hydration to help loosen secretions.
• Fever control with acetaminophen or ibuprofen to reduce discomfort and minimize the risk of febrile seizures.
• Humidification to ease breathing and reduce cough severity.

Monitoring and Follow-Up

Patients with pneumonia should be monitored closely for signs of improvement or deterioration, with follow-up chest radiographs generally not needed for patients who respond clinically 1. Failure to respond to treatment may indicate an incorrect diagnosis, inappropriate antibiotic choice, or complications such as pulmonary superinfection or empyema, necessitating a reevaluation of the treatment plan.

From the FDA Drug Label

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 Community-acquired pneumonia due to Chlamydophila pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae or Streptococcus pneumoniae in patients appropriate for oral therapy

Tratamiento para la neumonía: Azitromicina es efectiva en el tratamiento de la neumonía adquirida en la comunidad causada por Chlamydia pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae o Streptococcus pneumoniae en pacientes adecuados para terapia oral.

• La dosis recomendada para neumonía adquirida en la comunidad es de 500 mg como dosis única el día 1, seguida de 250 mg una vez al día los días 2 a 5 2.
• Es importante tener en cuenta que la azitromicina no debe ser utilizada en pacientes con neumonía que sean considerados inadecuados para terapia oral debido a enfermedad moderada a severa o factores de riesgo como fibrosis quística, infecciones adquiridas en el hospital, bacteriemia conocida o sospechada, hospitalización, pacientes ancianos o debilitados, o pacientes con problemas de salud subyacentes significativos que puedan comprometer su capacidad para responder a su enfermedad 2.

From the Research

Treatment for Pneumonia

The treatment for pneumonia can vary depending on the severity and cause of the infection.

• Antibiotics are commonly used to treat bacterial pneumonia, with options including levofloxacin, azithromycin, and ceftriaxone 3, 4, 5.
• Combination therapy, such as azithromycin plus ceftriaxone, may be used to treat moderate to severe community-acquired pneumonia (CAP) 4, 6.
• High-dose levofloxacin has been shown to be effective as a single-agent therapy for treating CAP, covering atypical pathogens 5.
• Monotherapy with a "respiratory quinolone" (i.e., levofloxacin, gatifloxacin, moxifloxacin, or gemifloxacin) is also considered an optimal first-line therapy for patients hospitalized with CAP 7.

Clinical Efficacy and Safety

• Studies have shown that levofloxacin monotherapy is at least as effective as combination regimens, such as azithromycin and ceftriaxone, in treating CAP 3, 5.
• Azithromycin plus ceftriaxone has been shown to be effective and well-tolerated in treating inpatients with CAP 4, 6.
• High-dose levofloxacin has been found to have a safety profile comparable to that of ceftriaxone plus azithromycin therapy 5.

Treatment Outcomes

• Clinical success rates (cure or improvement) have been reported to be high, ranging from 84% to 94%, in patients treated with levofloxacin or azithromycin plus ceftriaxone 3, 4, 5.
• Microbiological eradication rates have also been reported to be high, ranging from 68% to 92%, in patients treated with these regimens 3, 4, 6.