What is the treatment for pneumonitis?

From the Guidelines

The treatment for pneumonitis should focus on early diagnosis, cessation of the offending drug, and administration of glucocorticoids to facilitate the resolution of lung injury, particularly for those severely affected. Pneumonitis treatment varies based on the cause and severity, with the main goal of addressing the underlying inflammation in the lungs. According to the Fleischner Society position paper 1, early diagnosis and cessation of the offending drug intake promote optimal outcomes in patients with drug-related pneumonitis (DRP). Some key points to consider in the management of pneumonitis include:

• Discontinuing the offending drug, especially for immune checkpoint inhibitor (ICI)-related pneumonitis, as recommended by guidelines from the National Comprehensive Cancer Network, American Society of Clinical Oncology, Society for Immunotherapy of Cancer, and European Society for Medical Oncology 1
• Administering glucocorticoids, such as prednisone, to facilitate the resolution of lung injury, particularly for those severely affected (National Cancer Institute grade 3-4 pneumonitis) 1
• Providing supportive measures, including supplemental oxygen and noninvasive or invasive mechanical ventilator support, as needed 1
• Considering alternative treatments, such as infliximab, mycophenolate mofetil, or IV immunoglobulin, for patients without improvement on corticosteroids after 48 hours 1 It is essential to prioritize the patient's morbidity, mortality, and quality of life when making treatment decisions, and to individualize treatment based on the specific cause and severity of pneumonitis.

From the Research

Treatment for Pneumonitis

The treatment for pneumonitis, particularly community-acquired pneumonia (CAP), can vary depending on the severity and the patient's immune status.

• For hospitalized adults with moderate to severe CAP, treatment options include:
  • Levofloxacin monotherapy, which has been shown to be as effective as a combination regimen of azithromycin and ceftriaxone 2
  • A combination of intravenous azithromycin and ceftriaxone, followed by oral azithromycin, which has been found to be efficacious and well-tolerated 3
• For atypical pneumonia, azithromycin has been shown to be effective, with similar success rates for 3-day and 5-day courses 4
• Comparative studies have found that intravenous azithromycin plus ceftriaxone and intravenous levofloxacin with step-down oral therapy have similar efficacy and tolerability for hospitalized patients with moderate to severe CAP 5
• For immunocompromised adults with CAP, a consensus statement recommends a multidisciplinary approach to initial treatment strategies, including consideration of the patient's immune status, likely pathogens, and microbiologic workup 6

Key Considerations

• The choice of treatment should be based on the severity of the pneumonia, the patient's immune status, and the likelihood of resistant pathogens
• Combination therapy with a macrolide and a third-generation cephalosporin may be preferred over monotherapy with a fluoroquinolone to minimize the development of multiresistant nosocomial Gram-negative bacilli 5
• Treatment guidelines should be tailored to the individual patient's needs, taking into account their medical history, laboratory data, and treatment outcomes 2, 3, 4, 5, 6