Depending on what the causing agent is for the pneumonia, treatment of pneumonia has to be individualized.
However, in general, treatment is begun empirically based on a clinical diagnosis. After the sputum culture results are back from the lab therapy will be modified, based on sensitivity testing. The following table is a rough guideline with respect to what antibiotics usually work for which type of pneumonia (summarized from Ref. 9).
However, in 40 to 50% of patients there is no identifiable pathogen that can be isolated. The physician has to decide whether this is a potentially life threatening situation where invasive tests are warranted or whether it is safe to treat empirically with an antibiotic of the clinician’s choice.
Antibiotic therapy for common pneumonias
|pneumococcal pneumonia||penicillin G or V; ceftriaxone for resistant cases; quinolones|
|Haemophilus influenzae pneumonia||trimethoprim-sulfamethoxazole or cefuroxime; tetracycline in adults|
|Staphylococcal pneumonia||oxacillin or nafcillin; cephalosporin|
|pneumonia of Legionnaires’ disease||erythromycin or ciprofloxacin|
|Mycoplasma pneumonia||tetracycline or erythromycin|
|Chlamydial pneumonia||tetracycline or erythromycin|
|Friedländer’s pneumonia (Klebsiella)||tobramycin or gentamycin combined with ceftriaxone IV (infection specialist)|
|Viral pneumonia||acyclovir for herpes zoster (shingles), varicella virus(chickenpox); ganciclovir and immunoglobulin for cytomegaly virus; amantadine or rimantadine for influenza A|
|Aspiration pneumonia||IV clindamycin or ampicillin and metronidazole combined|
|Psittacosis pneumonia||tetracycline or doxacycline|
|Pneumocystis carinii pneumonia||trimethoprim-sulfamethoxazole; prophylaxis with aerosolized pentamidine|
|fungal||itraconazole or Amphotericine B for histoplasmosis, blastomycosis or coccidioidomycosis; fluconazole for Candida albicans; Amphotericine B for aspergillosis, mucormycosis or cryptococcosis|
If there is fluid in the chest cavity (pleural effusion), then a needle aspiration under X-ray guidance can get a pure sample for a bacterial culture. Similarly, if the patient is very sick, there might be bacteria in the blood, which can be cultured by taking three blood cultures at different times to increase the probability of one successful culture.
Another approach is to do an emergency bronchoscopy with the help of a pulmonologist to obtain a good specimen directly from the infected lung tissue for histological identification, Gram staining and various culture methods.
This may sound aggressive to some people, but the reality is that there are more and more resistant strains in the population, and with gram negative bacteria such as Klebsiella and Pseudomonas an early abscess can form and this is a feared complication of pneumonia.
Unfortunately even with the best of care in these cases there is still a mortality rate of 30 to 50%, even when the antibiotics fit. This is due to the fact that there is a high septicemia rate and these bacteria are notorious for producing resistant strains during even one course of treatment. Fortunately though most pneumonia cases out in the public with people who have a normal immune system are straight forward and resolve with oral antibiotics and supportive measures such as regularly inhaling hot steam and coughing up the secretions. It is important not to over-sedate the patient. Also, codeine should not be overused in cough suppressing medicines, and should perhaps not be used at all as it could make the pneumonia worse. Here are some conditions that predispose to developing pneumonia (click “pneumonia” and “some conditions predisposing to pneumonia”).
Generally speaking it is much more powerful to work on prevention by vaccinating against pneumococcal strains with Pneumovax 23, which will also stimulate the immune system at least partially to protect against other bacterial strains.
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