Pneumonia - Medications

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Antibiotics taken by mouth are generally enough for patients whose CAP is mild enough to be treated at home. Intravenous antibiotics are required for hospitalized patients with CAP. Antibiotic therapy should be given for a minimum of 5 days -- longer if the patient still has a fever and more than one sign of continuing severe illness.

In children, amoxicillin is the first line treatment in non-severe pneumonia.

Antibiotic Treatments for Hospital-Acquired (Nosocomial) Pneumonia

A broad range of antibiotics is available for treating hospital-acquired pneumonias and more severe forms of the condition. Factors that may determine the choice of an antibiotic include:

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• Immune status
• Patterns of antibiotic resistance within a particular hospital or community
• Recent antibiotic usage
• Type of bacteria causing the pneumonia
• Use of ventilators

Treatment of Viral Infections

There are not as many choices for treating viral pneumonia. Oseltamivir (Tamiflu) and zanamivir (Relenza) have been the recommended drugs for influenza A or B infections, but many strains of influenza A have become resistant. Their use is only recommended if they are started in the first 48 hours of symptoms. Taken early, these medications may be effective in reducing symptoms and duration of illness. [See In-Depth Report #94: Colds and influenza. ]

Patients with viral pneumonias are at risk for what are called "superinfections," which generally refers to a secondary bacterial infection, usually caused by S. pneumoniae, S. aureus, or H. influenzae. Doctors most commonly recommend treatment with amoxicillin-clavulanate, cefpodoxime, cefprozil, cefuroxime, or a respiratory fluoroquinolone if these secondary infections occur.

Patients with pneumonia caused by varicella-zoster and herpes simplex viruses are usually admitted to the hospital and treated with intravenous acyclovir for 7 days.

No antiviral drugs have been proven effective in adults with RSV, parainfluenza virus, adenovirus, metapneumovirus, the SARS coronavirus, or hantavirus. Treatment is largely supportive, with patients receiving oxygen and ventilator therapy as needed.