Pulmonology focuses on diagnosing and treating lung and airway conditions such as asthma, COPD, and pneumonia, as well as overall respiratory health.
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The management of pneumonia is a dynamic process that depends on the etiology, severity of illness, and patient comorbidities. The primary goals are to eradicate the infection, support respiratory function, and prevent complications. At Liv Hospital, we practice antibiotic stewardship to ensure the right drug is used for the correct bug, for the right duration, minimizing the risk of resistance while maximizing patient outcomes.
Antibiotics are the cornerstone of treatment for bacterial pneumonia. The choice of agent is initially empirical, based on guidelines and local resistance patterns.
For healthy outpatients with community-acquired pneumonia, a macrolide (such as azithromycin) or doxycycline is often the first-line treatment. In patients with comorbidities or recent antibiotic use, a respiratory fluoroquinolone (like levofloxacin) or a beta-lactam plus a macrolide is preferred. This ensures coverage against both typical (Streptococcus pneumoniae) and atypical pathogens.
Hospitalized patients typically receive intravenous antibiotics. A typical regimen involves a third-generation cephalosporin (like ceftriaxone) plus a macrolide. For hospital-acquired pneumonia or for those at risk for multidrug-resistant organisms, broad-spectrum agents that cover Pseudomonas and MRSA (such as piperacillin-tazobactam and vancomycin) are used until culture results allow de-escalation.
Since antibiotics are ineffective against viruses, specific therapies are needed for non-bacterial pneumonias.
For influenza pneumonia, neuraminidase inhibitors like oseltamivir are prescribed, ideally within 48 hours of symptom onset. For SARS-CoV-2, antivirals like remdesivir or nirmatrelvir/ritonavir may be indicated. Supportive care remains the mainstay for many other viral pneumonias.
Fungal pneumonias require prolonged courses of antifungal medications, such as fluconazole, voriconazole, or amphotericin B. Treatment duration can range from weeks to months, depending on the host’s immune status.
Beyond antimicrobial therapy, supportive measures are crucial for recovery.
Antipyretics such as acetaminophen and ibuprofen are used to control fever and relieve pleuritic chest pain. Adequate pain control is essential to allow deep breathing and coughing, which helps clear secretions.
Fever and tachypnea increase fluid loss. Maintaining adequate hydration helps thin respiratory secretions, making them easier to expectorate. Nutritional support is vital to provide the energy required for the increased metabolic demand of fighting the infection.
For patients with hypoxemia, respiratory support is escalated as needed.
Supplemental oxygen is provided via nasal cannula or face mask to maintain oxygen saturation above 92%. In patients with chronic lung disease like COPD, oxygen is titrated carefully to avoid carbon dioxide retention.
In severe cases leading to Acute Respiratory Distress Syndrome (ARDS), mechanical ventilation may be required. Non-invasive ventilation (like BiPAP) or High-Flow Nasal Cannula (HFNC) therapy can often prevent the need for intubation in select patients.
Complications of pneumonia require specific interventions.
If fluid accumulates around the lung (pleural effusion), diagnostic thoracentesis is performed. If the fluid is infected (empyema), it must be drained completely using a chest tube, as antibiotics alone cannot penetrate the pus cavity.
A lung abscess requires prolonged antibiotic therapy, often for several weeks. Percutaneous drainage or surgery is rarely needed unless the abscess fails to resolve or causes massive hemoptysis.
Close monitoring is essential to ensure resolution.
Patients are monitored for clinical stability, defined as normalization of vital signs (temperature, heart rate, respiratory rate, blood pressure). Most patients stabilize within 3 to 5 days of appropriate therapy.
A follow-up chest X-ray is typically recommended 6 to 8 weeks after treatment, especially in smokers or patients over 50. This confirms the clearing of the infiltrate and ensures that the pneumonia was not masking an underlying lung malignancy.
Liv Hospital is committed to responsible antibiotic use. We emphasize de-escalation of therapy once a specific pathogen is identified, switching from IV to oral antibiotics as soon as the patient is clinically stable, and adhering to the shortest effective duration of therapy (typically 5 to 7 days for uncomplicated CAP) to reduce the emergence of resistant bacteria.
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No, antibiotics only work for bacterial pneumonia; viral pneumonia requires antivirals or supportive care, and fungal pneumonia requires antifungal medication.
Most people feel better within a week or two, but fatigue and a lingering cough can persist for a month or more; full recovery depends on age and overall health.
Mild pneumonia in healthy people can often be treated at home with oral antibiotics and rest, but severe symptoms or high-risk individuals require hospitalization.
Staying hydrated helps to thin the mucus in your lungs, making it easier to cough up, and replaces fluids lost through fever and rapid breathing.
If symptoms don’t improve after a few days, the bacteria might be resistant to the drug, it might be a viral infection, or a complication, such as an abscess, may have developed, requiring further testing.
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