Pneumonia - Treatment

Treatment

The approach to treating patients with pneumonia generally involves:

• Deciding who can be treated at home and who needs to be in the hospital
• Deciding whether a patient needs antibiotics, and which antibiotics are appropriate
• Providing appropriate supportive care
• Deciding what follow-up and preventive care are needed

Whether patients are treated at home or admitted to the hospital, receiving their first dose of antibiotics quickly improves the outcome of the illness and the speed at which they get better.

Determining the Need for Hospitalization

Studies indicate that many patients do not need to be hospitalized for pneumonia, and can be safely treated at home. Likewise, many patients who are admitted to the hospital could be released sooner. A number of strategies are being devised to determine which patients can be safely discharged and when they can be discharged. In general, low-risk patients with mild-to-moderate pneumonia do just as well when treated as outpatients. They return to work and normal activities faster than those treated in the hospital.

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A variety of guidelines and tools have been developed to help determine who can safely be treated at home and who cannot. Commonly used tools include the Pneumonia Severity Index (PSI), British Thoracic Society Rule (BSR) and CURB-65. All of these assessment tools are looking for risk factors. The more of these risk factors that are present, the less likely that the patient can be safely treated at home. Several of these risk factors determine a specific score. All of them must be used along with the doctor's clinical judgment.

Some of the important factors used to make a decision include:

Demographics.

• Patients who have been living in a nursing home or other residential facility are of greater concern.
• Elderly patients and infants, particularly infants who are less than 1 month old, are more likely to be admitted.

Other Medical Illnesses. Patients may be considered at greater risk if they have:

• Cancer
• Heart failure
• History of stroke
• Kidney failure
• Liver disease