Pneumonia - Treatment

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Findings on a Physical Exam. Concerning findings include:

• Altered mental status (confused, less responsive)
• Appearance of being dehydrated, especially if the person is unable to drink fluids
• Fast breathing (more than 30 breaths per minute)
• Heart rate greater than 120 beats per minute
• Systolic blood pressure less than 90 mmHg
• Temperature greater than 104 °F

Laboratory and X-ray Findings. Laboratory findings that are of concern include:

• Elevated blood sugar
• Fluid in the sac around the lung (on chest x-ray)
• Low oxygen in the blood
• Low sodium levels
• Poor kidney function
• Significant anemia (hematocrit less than 30%)

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Patients with very few of these risks often can be discharged with outpatient care only. This determination can often be made with a simple physical examination and history. Sometimes a patient only needs to be hospitalized for 24 hours for observation.

Patients with higher scores on these assessment tests often have many risk factors and usually are hospitalized.

When possible, treatment of community-acquired pneumonia should be started within 4 hours of admission to the emergency room or hospital to reduce the chances of mortality and decrease the amount of time a patient needs to spend in the hospital.

Home care may be possible, even in severe cases, when there is good support and available home nursing services. Often, caregivers can even be trained to administer intravenous antibiotics and chest therapy to patients at home.

Home Treatment

The following tips are suggested:

• Drink plenty of liquids (1 - 2 quarts daily).
• Take oral temperature several times a day. Call your doctor if it does not come down with treatment.
• Do not suppress a cough. Coughing is an important reflex for clearing the lungs. Some doctors advise taking expectorants, such as guaifenesin (Breonesin, Glycotuss, Glytuss, Hytuss, Naldecon Senior EX, Robitussin) to loosen mucus. However, there is no proof that any of these products make much difference in a patient's outcome.
• Mild pain can be treated with aspirin (in adults only), acetaminophen (Tylenol), or ibuprofen (Advil, Motrin).
• For severe pain, codeine or another stronger pain reliever may be prescribed. It should be noted, however, that codeine and other narcotics suppress coughing, so they should be used with care in pneumonia. Such pain relievers often require monitoring.
• Finish entire course of antibiotics.
• Don't smoke.