Pneumonia - Treatment Overview

Treatment Overview

Doctors use antibiotics to treat pneumonia caused by bacteria, the most common cause of the condition. The number of days you take antibiotics depends on your general health, how serious your pneumonia is, and the type of antibiotic you are taking.

Your doctor will choose your antibiotic based on a number of things, including your age, your symptoms and how severe they are, and whether you need to go to the hospital.

Although experts differ on their antibiotic recommendations, the first antibiotic used usually is one that works against a wide range of bacteria (broad-spectrum antibiotic). All antibiotics used have a high cure rate for pneumonia.⁶

If you do not have to go to the hospital, your doctor may use any of the following antibiotics:

• Macrolides, such as azithromycin, clarithromycin, and erythromycin.
• Tetracyclines, such as doxycycline.
• Fluoroquinolones, such as gemifloxacin, levofloxacin, and moxifloxacin.

If you have to go to the hospital, your doctor may use any of the above antibiotics. Other antibiotics that your doctor may use in this situation include:

• Cephalosporins, such as ceftriaxone, cefotaxime, ceftazidime, or cefepime.
• Penicillins, such as amoxicillin, amoxicillin with clavulanate, ampicillin, and ticarcillin with clavulanate.
• Vancomycin.

Antibiotics usually work well with younger, otherwise healthy people with strong immune systems. You most likely will see some improvement in symptoms within 2 to 3 days. Unless you get worse during this time, your doctor usually will not change your treatment for at least 3 days. If there is no improvement or if your symptoms get worse, you may need culture and sensitivity testing. These tests help identify the organism that is causing your symptoms and determine whether the bacteria may be resistant to the antibiotic.

You usually will not have to go to the hospital unless you:

• Are older than 65.
• Have other health problems, such as chronic obstructive pulmonary disease, heart failure, asthma, diabetes, long-term (chronic) kidney failure, or chronic liver disease.
• Cannot care for yourself or would not be able to tell anyone if your symptoms got worse.
• Have severe illness with less oxygen getting to the tissues (hypoxia).
• Have chest pain caused by inflammation of the lining of the lung (pleurisy) and therefore are not able to cough up mucus effectively and clear the lungs.
• Are being treated outside a hospital and are not getting better (such as your shortness of breath not improving).
• Are not able to eat or keep food down so that you need to take fluids through a vein (intravenous).

Viral pneumonia

Pneumonia also can be caused by viruses, such as those that cause influenza (flu) and chickenpox (varicella).

• At this time, there is no proven medicine to treat pneumonia caused by the influenza virus. Home treatment, such as rest and taking care of your cough, is the only treatment.
• Varicella pneumonia, which is rare, can be treated with the antiviral medicine acyclovir.

What To Think About

If you do not need to go to the hospital for pneumonia, it is not usually necessary to identify the organism causing the pneumonia before starting treatment. If you do go to the hospital, you will probably have some additional testing to identify the bacteria.

Getting started early on antibiotics results in better recovery, especially in those age 65 and older who have severe symptoms.⁶

In most cases pneumonia is a short-term, treatable illness. But frequent bouts of pneumonia can be a serious complication of a long-term (chronic) illness, such as chronic obstructive pulmonary disease (COPD). If you have a severe long-term illness, it may be difficult to treat your pneumonia, or you may choose not to treat it. You and your doctor should discuss this. This discussion may include the possibility of your creating an advance directive. For more information, see the topic Writing an Advance Directive or Care at the End of Life.