Bacterial pneumonia medical therapy

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Editor(s)-in-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-632-7753; Philip Marcus, M.D., M.P.H.[2]

Overview

Antibiotics are the treatment of choice for bacterial pneumonia. The antibiotic choice depends on the nature of the pneumonia, the microorganisms most commonly causing pneumonia in the geographical region, and the immune status and underlying health of the individual. In the United Kingdom, amoxicillin is used as first-line therapy in the vast majority of patients who acquire pneumonia in the community, sometimes with added clarithromycin. In North America, where the "atypical" forms of community-acquired pneumonia are becoming more common, clarithromycin, azithromycin, or fluoroquinolones as single therapy, have displaced the amoxicillin as first-line therapy. Local patterns of antibiotic-resistance should always be considered when initiating pharmacotherapy. In hospitalized individuals or those with immune deficiencies, local guidelines determine the selection of antibiotics. These antibiotics are typically given through an intravenous line.

Medical Therapy

Treatment of gram-positive organisms

• Streptococcus pneumoniae - amoxicillin (or erythromycin in patients allergic to penicillin); cefuroxime and erythromycin in severe cases.
• Staphylococcus aureus - flucloxacillin (to counteract the organism's β-lactamase)

Treatment of gram-negative organisms

• Haemophilus influenzae
• Klebsiella pneumoniae
• Escherichia coli
• Pseudomonas aeruginosa
• Moraxella catarrhalis

Treatment of atypical organisms

Most atypical causes of pneumonia require treatment for 14-21 days.

• Chlamydophila pneumoniae - doxycycline
• Chlamydophila psittaci - erythromycin
• Mycoplasma pneumoniae - erythromycin
• Coxiella burnetti - erythromycin
• Legionella pneumophila- erythromycin, with rifampicin sometimes added.

People who have difficulty breathing due to pneumonia may require extra oxygen. An extremely sick individual may requireartificial ventilation and intensive care as life-saving measures while his or her immune system fights off the infectious cause with the help of antibiotics and other drugs.