What is the treatment for viral pneumonia?

Treatment of Viral Pneumonia

The treatment of viral pneumonia primarily consists of supportive care, including oxygen therapy, adequate nutrition, and symptomatic management, with specific antiviral medications used only in select cases based on the causative virus. 1, 2

Supportive Care

• Patients should rest in bed with continuous monitoring of vital signs (heart rate, pulse oxygen saturation, respiratory rate, blood pressure) 1
• Regular laboratory monitoring is essential, including blood routine, CRP, PCT, organ function tests, coagulation function, arterial blood gas analysis, and chest imaging 1
• Nutritional support is critical:
  • For patients with nutrition risk scores <3 points: provide protein-rich foods with ideal energy intake of 25-30 kcal/(kg·d) and protein intake of 1.5 g/(kg·d) 2
  • For patients with nutrition risk scores ≥3 points: provide early nutritional support with increased protein intake through oral supplements 2-3 times daily (≥18g protein/time) 2
  • Consider enteral nutrition tube placement when oral intake is insufficient 1
• Symptomatic fever management: When temperature exceeds 38.5°C, ibuprofen can be used (oral, 0.2g per time, every 4-6h as needed, maximum 4 times in 24h) 1

Oxygen Therapy and Respiratory Support

• Provide effective oxygen therapy based on severity, with options including: 1, 2
  • Nasal catheter
  • Mask oxygen
  • High flow nasal oxygen therapy (HFNO)
  • Non-invasive ventilation (NIV)
  • Invasive mechanical ventilation
• For patients with refractory hypoxemia not responding to conventional measures, consider Extracorporeal Membrane Oxygenation (ECMO) 1, 2
• For patients with moderate-severe ARDS (PaO₂/FiO₂ < 150), implement protective lung ventilation strategies with higher PEEP, prone positioning for >12 hours daily, and consider deep sedation and analgesia muscle relaxation within the first 48 hours of mechanical ventilation 1

Antiviral Therapy

• Currently, there is limited evidence from randomized controlled trials supporting specific antiviral treatments for most viral pneumonias 1, 3
• For specific viral etiologies, consider: 4, 3
  • Influenza: Neuraminidase inhibitors (e.g., oseltamivir) have been shown to reduce the need for ventilatory support and mortality rates
  • For other respiratory viruses, antiviral options remain limited and are typically virus-specific 5
• When used, antiviral therapy should be initiated as early as possible in the disease course 1, 4

Prevention and Management of Complications

Secondary Bacterial Infections

• Avoid blind or inappropriate use of antibacterial drugs, especially broad-spectrum combinations 1, 6
• Perform bacteriological surveillance and administer appropriate antibacterial drugs only when secondary bacterial infection is suspected 1
• For mild cases with suspected bacterial co-infection, consider antibiotics effective against community-acquired pneumonia (amoxicillin, azithromycin, or fluoroquinolones) 1, 6
• For severe cases, empirical antibacterial treatment should cover all possible pathogens, with de-escalation once the causative bacteria are identified 1

Other Supportive Measures

• For patients with dyspnea, cough, and increased respiratory secretions, consider selective (M1, M3) receptor anticholinergic drugs to reduce secretions and improve pulmonary ventilation 1, 2
• Use H2 receptor antagonists or proton pump inhibitors in patients with gastrointestinal bleeding risk factors 1, 2
• Evaluate risk of venous thromboembolism and use prophylactic low-molecular-weight heparin or heparin in high-risk patients without contraindications 1, 2

Corticosteroid Use

• The use of corticosteroids in viral pneumonia is controversial and requires careful consideration 1, 4
• For patients with rapid disease progression or severe illness, methylprednisolone 40-80 mg per day (not exceeding 2 mg/kg daily) may be considered for short periods (3-5 days) 1, 2
• Corticosteroids may improve clinical symptoms, reduce disease progression, and accelerate absorption of lung lesions in severe cases, but do not shorten hospital stay 1
• Be cautious of potential adverse reactions with hormone therapy 1

Special Considerations

• Viral pneumonia treatment approaches have evolved significantly since the COVID-19 pandemic, with greater recognition of the importance of early diagnosis and the impact of co-infections 7
• The elderly and immunocompromised patients are particularly vulnerable and may require more aggressive supportive care 4
• Long-term sequelae of severe viral pneumonia require ongoing monitoring and management, particularly in cases of severe disease 7