From the Guidelines
Treatments for pneumonia typically involve antibiotics, with the choice of antibiotic depending on the severity and suspected cause of the infection.
Treatment Options
- For outpatients with community-acquired pneumonia (CAP), treatment options include macrolides (e.g., azithromycin, clarithromycin), doxycycline, amoxicillin, amoxicillin-clavulanate, oral cephalosporins (e.g., cefpodoxime, cefprozil), and fluoroquinolones (e.g., levofloxacin, moxifloxacin) 1.
- For inpatients with CAP, treatment options include a respiratory fluoroquinolone alone or an advanced macrolide plus a β-lactam, with consideration of coverage for Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA) if suspected 1.
- For hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), treatment options include monotherapy with a broad-spectrum agent (e.g., ertapenem, ceftriaxone, cefotaxime, moxifloxacin, or levofloxacin) or combination therapy with a β-lactam plus a macrolide or a respiratory quinolone, with consideration of coverage for MRSA and Pseudomonas aeruginosa if suspected 1.
Key Considerations
- Severity of illness: Patients with severe pneumonia, such as those requiring intensive care unit (ICU) admission, may require more broad-spectrum antibiotic coverage and combination therapy 1.
- Suspected cause: The choice of antibiotic should be guided by the suspected cause of the pneumonia, including consideration of viral, bacterial, and atypical pathogens 1.
- Local resistance patterns: Antibiotic choices should be informed by local patterns of antibiotic resistance and organism prevalence 1.
- Clinical response: Antibiotic therapy should be modified based on the patient's clinical response and the results of microbiologic testing 1.
From the Research
Treatment Options for Pneumonia
- Antimicrobial treatment is crucial in improving survival among critically ill patients with pneumonia 2
- The choice of antibiotic is usually determined by the degree of illness and microbiological epidemiology 3
- Initial treatment of pneumonia includes supportive care as needed (oxygen, intubation, and bronchodilators) and an empirically chosen antibiotic 3
- Appropriate choices for antibiotics include macrolides and azalides for low-risk out-patients, and either a combination cephalosporin and macrolide or an extended-spectrum fluoroquinolone for high-risk out-patients and in-patients 3
Adjunctive Therapies
- Adjunctive non-antibiotic therapeutic strategies aimed at modulation of the inflammatory response or at the micro-organism itself are being explored 4
- Immunomodulatory compounds, such as forsythin, are being investigated as potential therapeutic agents for pneumonia treatment 5
- New molecular diagnostic techniques appear promising for early detection of microbes involved in severe pneumonia 6
Management of Severe Pneumonia
- Prompt and appropriate antimicrobial therapy is essential in the management of severe pneumonia 2, 6
- The optimization of antibiotic therapy may be obtained by applying their pharmacodynamic/pharmacokinetic properties 6
- Several new strategies have been implemented for the management of acute respiratory failure (ARF) due to severe pneumonia, including nonconventional strategies for ARF management 6