From the Guidelines
Post-viral pneumonia is a lung infection that develops following a viral respiratory infection, and treatment primarily involves supportive care, with antibiotics recommended only in cases of confirmed secondary bacterial infection, such as with S. aureus, S. pneumoniae, H. influenza, and group A Streptococcus, as seen in patients with confirmed Influenza 1. The condition occurs because viral infections can damage the respiratory epithelium, leading to inflammation and impaired mucociliary clearance, which can persist even after the virus has been cleared. Some key points to consider in the management of post-viral pneumonia include:
- Supportive care with rest, adequate hydration, and over-the-counter medications for symptom relief, such as acetaminophen (500-1000mg every 6 hours as needed) or ibuprofen (400-600mg every 6-8 hours with food) for fever and pain 1.
- Use of a humidifier to ease breathing and consideration of an incentive spirometer to prevent atelectasis.
- Monitoring for signs of secondary bacterial infection, such as shortness of breath, persistent high fever (>101°F or 38.3°C), or worsening cough with purulent sputum, which may require hospitalization and antibiotic treatment.
- Patients with underlying conditions like COPD, asthma, or immunocompromise may require closer monitoring and more aggressive management.
- The IDSA/ATS 2019 guideline recommends clinicians to continue antibiotics until the patient achieves stability using a validated measure of clinical stability, including normalization of vital sign abnormalities, oxygen saturation, patient’s ability to eat, and normal mentation, and the duration is not less than a total of 5 days 1. Some newer antibiotics, such as solithromycin, nemonaxacin, delafoxacin, omadacycline, and lefamulin, have shown promise in the treatment of community-acquired pneumonia, including post-viral pneumonia, with comparable or superior efficacy to traditional antibiotics, and may be considered in certain cases 1. However, the choice of antibiotic should be guided by the severity of the infection, the presence of underlying conditions, and the risk of antibiotic resistance, as well as the results of cultures and susceptibility testing, if available. In general, the treatment of post-viral pneumonia should be individualized and based on the specific needs and circumstances of each patient, with a focus on supportive care, prevention of complications, and prompt treatment of any secondary bacterial infections that may arise.
From the FDA Drug Label
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 causes of post-viral pneumonia are not directly addressed in the label. The treatment of post-viral pneumonia is not directly addressed in the label, however community-acquired pneumonia can be treated with azithromycin if caused by Chlamydia pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, or Streptococcus pneumoniae in patients suitable for oral therapy 2.
From the Research
Causes of Post-Viral Pneumonia
- Post-viral pneumonia can be caused by secondary bacterial infections, which can occur after a respiratory viral infection 3, 4, 5.
- The type of preceding respiratory virus can influence the type of bacteria that causes post-viral pneumonia 3.
- Common bacterial pathogens that cause post-viral pneumonia include Staphylococcus aureus, Klebsiella pneumoniae, Mycoplasma pneumoniae, and Streptococcus pneumoniae 3, 4, 5.
Treatments of Post-Viral Pneumonia
- Antiviral therapy, such as oseltamivir, can improve survival in patients with secondary bacterial pneumonia after influenza 6.
- Antibiotic therapy is standard for treating secondary bacterial pneumonia, but its use during influenza infection can have detrimental effects on lung immunity 7.
- The choice of empirical antibiotics may depend on the type of preceding respiratory virus and the patient's age 3.
- Quinolones, cephalosporins, and macrolides are commonly used antibiotics for treating post-viral pneumonia, but antibiotic-resistant strains of bacteria can be a concern 4.