What is the diagnosis and treatment for Pneumonia (inflammation of the lungs)?

From the Guidelines

Pneumonia should be treated with empiric antibiotics as soon as possible, taking into account the individual risk of mortality, severity of pneumonia, and local patterns of microbial resistance, as recommended by the guidelines for the management of adult lower respiratory tract infections 1. The diagnosis of pneumonia involves identifying the cause and severity of the infection, which can be done through a combination of physical examination, medical history, and diagnostic tests such as chest X-rays and lower respiratory tract cultures.

• The treatment approach should be based on the severity of pneumonia, with mild cases managed ambulatorily, moderate cases requiring hospitalization, and severe cases requiring intensive care unit (ICU) admission.
• For bacterial pneumonia, antibiotics are the primary treatment, with common options including amoxicillin, azithromycin, or doxycycline, as suggested by the guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia 1.
• Viral pneumonia, on the other hand, does not respond to antibiotics and typically requires rest, fluids, and fever-reducing medications like acetaminophen.
• Supportive care, including rest, adequate hydration, and fever management, is also crucial in the treatment of pneumonia.
• Prevention strategies, such as vaccination, good hand hygiene, avoiding smoking, and maintaining overall health, can help reduce the risk of developing pneumonia. Key considerations in the treatment of pneumonia include:
• The need for early, appropriate antibiotics in adequate doses, while avoiding excessive antibiotics by de-escalation of initial antibiotic therapy, based on microbiologic cultures and the clinical response of the patient 1.
• The importance of taking local microbiologic data into account when adapting treatment recommendations to any specific clinical setting 1.
• The use of either "semiquantitative" or "quantitative" culture data for the management of patients with pneumonia 1.

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 Azithromycin should not be used in patients with pneumonia who are judged to be inappropriate for oral therapy because of moderate to severe illness or risk factors such as any of the following: patients with cystic fibrosis, patients with nosocomially acquired infections, patients with known or suspected bacteremia, patients requiring hospitalization, elderly or debilitated patients, or patients with significant underlying health problems that may compromise their ability to respond to their illness (including immunodeficiency or functional asplenia).

The diagnosis of pneumonia is not explicitly stated in the provided drug labels. The treatment for pneumonia with azithromycin is recommended for community-acquired pneumonia due to specific bacteria, including Chlamydia pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, or Streptococcus pneumoniae, in patients suitable for oral therapy. Key considerations for treatment include:

• Patient suitability: Azithromycin should only be used in patients appropriate for oral therapy.
• Bacterial causes: Azithromycin is effective against specific bacterial causes of community-acquired pneumonia.
• Contraindications: Patients with moderate to severe illness, certain underlying health conditions, or risk factors should not be treated with azithromycin for pneumonia. 2

From the Research

Diagnosis of Pneumonia

• Community-acquired pneumonia is a common infection encountered in clinical practice and is the leading cause of death due to infectious disease in the United States 3
• Diagnosis of pneumonia is confirmed by chest radiographs, which are strongly recommended for all suspected patients, particularly those requiring hospitalization 4
• Sputum Gram's stain and culture are also recommended to establish etiology and guide therapy 4

Treatment of Pneumonia

• Primary treatment for community-acquired pneumonia in young adults without comorbidities is erythromycin 3
• Older adults or those with comorbidities should be treated with erythromycin plus trimethoprim-sulfamethoxazole, a second- or third-generation cephalosporin, or a new macrolide 3
• Empiric therapy for moderately or severely ill hospitalized patients usually begins with erythromycin plus a second- or third-generation cephalosporin 3
• Macrolides, doxycycline, and fluoroquinolones are suggested for primary empiric therapy, since each has activity against common bacterial pathogens and atypical agents 4
• Combination antibiotic therapy achieves a better outcome compared with monotherapy and should be given to certain subsets of patients, including outpatients with comorbidities and previous antibiotic therapy, nursing home patients with CAP, hospitalized patients with severe CAP, and those with bacteremic pneumococcal CAP 5

Antibiotic Therapy

• The choice of antibiotic therapy depends on the severity of the disease, the presence of comorbidities, and the likelihood of antibiotic resistance 3, 6
• Oral antibiotics can be used to treat the majority of patients presenting with community-acquired pneumonia, and selection requires a knowledge of the classes of antibiotics available, utility of diagnostic testing, and epidemiology of pneumonia 7
• Combination therapy that includes a macrolide is associated with a better outcome, due to its wide coverage of atypical pneumonia, polymicrobial pneumonia, or resistant Streptococcus pneumoniae, as well as its anti-inflammatory properties 5