From the Guidelines
The primary distinction in treating pneumonia and pneumonitis lies in their underlying causes, with pneumonia being an infection-based condition typically requiring antibiotics, and pneumonitis being a non-infectious inflammation often managed with corticosteroids and removal of the triggering agent. When considering the treatment of pneumonitis, particularly in the context of immune checkpoint inhibitor (ICPi) therapy, corticosteroids are recommended as the initial treatment for symptomatic cases, with clinical improvement seen in over 80% of cases 1. The approach to pneumonia, on the other hand, involves identifying and treating the causative pathogen with appropriate antibiotics, alongside supportive care measures such as oxygen therapy and hydration.
Key Differences in Treatment Approach
- Pneumonia Treatment:
- Antibiotics tailored to the causative organism
- Supportive care: oxygen therapy, hydration, antipyretics
- Examples of antibiotic regimens: amoxicillin, azithromycin, doxycycline for community-acquired bacterial pneumonia
- Pneumonitis Treatment:
- Removal of the triggering agent when possible
- Corticosteroids to reduce inflammation, such as prednisone
- Treatment of underlying conditions or causes, such as discontinuation of offending medications or environmental modifications for hypersensitivity pneumonitis
Considerations for ICPi-Related Pneumonitis
- The incidence of pneumonitis in patients treated with ICPi therapy can vary, with a reported overall incidence of 2.7% in studies investigating anti–PD-1/PD-L1 therapy 1.
- The decision to proceed with biopsy in cases of suspected pneumonitis should be made after careful risk-benefit analysis, as it may assist in ruling out other etiologies or distinguishing chronic ICPi pneumonitis 1.
- For steroid-refractory ICPi pneumonitis, options include infliximab, mycophenolate mofetil, intravenous immune globulin (IVIG), or cyclophosphamide, based on retrospective experiences 1.
From the Research
Treatment Differences
The treatment differences between pneumonia and pneumonitis are based on the underlying cause of the infection.
- Pneumonia is typically treated with antibiotics, such as azithromycin, amoxicillin/clavulanate, or erythromycin, depending on the causative pathogen 2, 3, 4.
- Pneumonitis, on the other hand, may be treated with anti-inflammatory medications, such as corticosteroids, or antimicrobial agents, depending on the underlying cause 5.
Causative Pathogens
The choice of treatment also depends on the causative pathogen.
- Bacterial pneumonia is typically treated with antibiotics, such as azithromycin or amoxicillin/clavulanate 2, 3, 4.
- Viral pneumonia, such as that caused by influenza or respiratory syncytial virus, may be treated with antiviral medications, such as ribavirin or amantadine/rimantadine 5.
- Fungal pneumonia may be treated with antifungal medications.
Treatment Outcomes
The treatment outcomes for pneumonia and pneumonitis can vary depending on the underlying cause and the effectiveness of treatment.
- Azithromycin has been shown to be effective in the treatment of community-acquired pneumonia, with clinical success rates of 94.6% to 96.2% 3.
- Amoxicillin/clavulanate and erythromycin have also been shown to be effective in the treatment of community-acquired pneumonia, with clinical success rates of 87.1% to 96.2% 3, 4.
Diagnosis and Management
Accurate diagnosis and management of pneumonia and pneumonitis are crucial to improve outcomes.