What is double pneumonia, also known as bilateral pneumonia?

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Last updated: April 23, 2025View editorial policy

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From the Guidelines

Double pneumonia is a serious infection that affects both lungs simultaneously, requiring prompt treatment to reduce morbidity and mortality, and typically involves antibiotics such as a macrolide and b-lactam regimen or a fluoroquinolone alone for empiric treatment, as recommended by guidelines from the IDSA, the ATS, and the Canadian Infectious Diseases Society and Canadian Thoracic Society 1.

Causes and Symptoms

Double pneumonia can be caused by bacteria, viruses, fungi, or other pathogens, and common symptoms include fever, chills, cough with phlegm, shortness of breath, chest pain, fatigue, and sometimes confusion, especially in older adults. The mortality rate for bacteremic pneumococcal pneumonia is 6%–20% 1, highlighting the need for effective treatment.

Treatment

Treatment typically depends on the cause but often includes antibiotics for bacterial pneumonia, such as a macrolide and b-lactam regimen or a fluoroquinolone alone, as recommended by guidelines from the IDSA, the ATS, and the Canadian Infectious Diseases Society and Canadian Thoracic Society 1. For ICU patients, initial empiric treatment started before any culture data are available should be with a b-lactam plus either a macrolide or a fluoroquinolone 1.

Risk Factors

People with weakened immune systems, the elderly, young children, and those with chronic health conditions are at higher risk for developing severe double pneumonia and may require hospitalization for proper treatment and monitoring. The guidelines from the IDSA, the ATS, and the Canadian Infectious Diseases Society and Canadian Thoracic Society recommend considering variables such as the patient’s age and any comorbid conditions, as well as the clinical, bacteriological, and radiographic response to therapy, when deciding on treatment 1.

Key Considerations

  • Double pneumonia is generally more serious than single-lung pneumonia because it affects a larger portion of the respiratory system, potentially leading to more severe oxygen deprivation and systemic illness.
  • Prompt treatment is essential to reduce morbidity and mortality.
  • Treatment should be guided by guidelines from reputable organizations, such as the IDSA, the ATS, and the Canadian Infectious Diseases Society and Canadian Thoracic Society 1.

From the Research

Definition of Double Pneumonia

  • Double pneumonia refers to an infection that affects both lungs, rather than just one [@\1@, @\2@, @\3@, @\4@, @\5@].
  • It can be caused by a variety of factors, including bacteria, viruses, and fungi.
  • The symptoms of double pneumonia can include cough, fever, chest pain, and shortness of breath.

Causes and Risk Factors

  • Double pneumonia can be caused by a variety of factors, including:
    • Bacterial infections, such as Streptococcus pneumoniae [@\1@, @\2@, @\3@, @\4@, @\5@]
    • Viral infections, such as influenza [@\1@, @\2@, @\3@, @\4@, @\5@]
    • Fungal infections, such as Pneumocystis jirovecii [@\1@, @\2@, @\3@, @\4@, @\5@]
  • Risk factors for double pneumonia include:
    • Age, with older adults being more susceptible [@\1@, @\2@, @\3@, @\4@, @\5@]
    • Underlying medical conditions, such as chronic obstructive pulmonary disease (COPD) [@\1@, @\2@, @\3@, @\4@, @\5@]
    • Weakened immune system, such as in people with HIV/AIDS [@\1@, @\2@, @\3@, @\4@, @\5@]

Treatment and Management

  • Treatment for double pneumonia typically involves antibiotics, such as levofloxacin or ceftriaxone, and may also include supportive care, such as oxygen therapy and hydration [@\1@, @\2@, @\3@, @\4@, @\5@].
  • The choice of antibiotic will depend on the cause of the infection and the severity of the symptoms.
  • In severe cases, hospitalization may be necessary to provide close monitoring and supportive care.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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