Pulmonologists' Hospital Treatment Plan For Pneumonia

Pneumonia is a serious condition that can lead to respiratory failure or acute respiratory distress syndrome (ARDS). It is typically caused by bacteria or viruses, with bacterial pneumonia being more common and more severe. Treatment for pneumonia depends on its cause and severity, as well as the patient's age and overall health. In hospital, pulmonologists—who specialize in respiratory conditions—may treat bacterial pneumonia with antibiotics, intravenous fluids, oxygen therapy, and other breathing treatments. Viral pneumonia often requires no specific treatment beyond symptom management, rest, and drinking plenty of fluids.

Antibiotics for bacterial pneumonia

Antibiotics are an essential treatment for bacterial pneumonia, which is more common and more severe than viral pneumonia. They target and kill the bacteria causing the infection in the lungs, thereby reducing inflammation and helping the patient to breathe more easily and recover faster. Antibiotics do not work against viral infections, so it is important to ensure that the pneumonia is bacterial before administering them.

The choice of antibiotic will depend on the type and severity of the infection, as well as any underlying health conditions. For instance, penicillin, amoxicillin, and clarithromycin are commonly prescribed antibiotics for pneumonia. The possibility of Legionella infection should also be considered when evaluating community-acquired pneumonia (CAP) as delayed treatment can significantly increase mortality.

Initial empiric therapy for hospitalized patients should be broad and cover the likely causative organisms. Antibiotic therapy must be selected with the most prevalent causative organism, S pneumoniae, in mind. The prevalence and resistance patterns of MDR pathogens vary between institutions, so appropriate initial antibiotic therapy for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) may vary according to the hospital site.

Antibiotics should be taken exactly as prescribed by the healthcare provider, including taking the prescribed dose at the recommended times and completing the full course of treatment, even if symptoms improve. Failure to do so can lead to the development of antibiotic-resistant bacteria and a higher risk of recurrence or complications.

Antivirals for viral pneumonia

Pneumonia is a lung infection caused by bacteria, viruses, or fungi. The treatment for pneumonia depends on the type of pneumonia, the severity of the case, the patient's age, and other health conditions. Bacterial pneumonia is treated with antibiotics, while viral pneumonia usually resolves on its own without specific treatment. However, antiviral medications may be prescribed to reduce the duration and severity of viral pneumonia.

Viral pneumonia is more likely to occur in children, the elderly, or those with weakened immune systems. It often presents with flu-like symptoms, such as fever, chills, muscle pain, and extreme tiredness or weakness. In some cases, it can lead to difficulty breathing, loss of appetite, and restlessness.

Antiviral medications can be used to treat viral pneumonia, although there are limited options available. Oseltamivir (Tamiflu®), zanamivir (Relenza®), and peramivir (Rapivab®) are commonly prescribed antivirals for viral pneumonia. Oseltamivir inhibits neuraminidase, a glycoprotein on the influenza virus, thereby reducing viral spread. Peramivir works similarly by inhibiting viral neuraminidase, an enzyme that releases viral particles from infected cells. Zanamivir is also an influenza drug that can be used prophylactically or therapeutically.

Other antiviral agents that have been used to treat viral pneumonia include amantadine, rimantadine, ribavirin, acyclovir, ganciclovir, and foscarnet. Acyclovir is effective for varicella and herpes simplex pneumonia, while ganciclovir is used for immunocompromised patients with CMV pneumonia. Additionally, remdesivir and nirmatrelvir/ritonavir have been approved for the prevention and treatment of COVID-19.

While antivirals can be beneficial in treating viral pneumonia, it is important to note that they do not work against all viruses that cause pneumonia. Symptom management and rest are often crucial components of the treatment plan. Patients are advised to control fever and body aches with medications such as aspirin, non-steroidal anti-inflammatory drugs (NSAIDs), or acetaminophen. Staying hydrated is also important to loosen secretions and bring up phlegm.

Intravenous fluids and oxygen therapy

Oxygen therapy is a common treatment for lung diseases and can be used to help patients who cannot breathe adequately on their own. This can be administered through a nasal cannula or mechanical ventilation. Mechanical ventilation involves the use of a machine called a ventilator or respirator and can be either non-invasive or invasive. The effectiveness of oxygen therapy as a treatment for pneumonia is not well known, and it is just one of several treatments used by physicians.

In addition to intravenous fluids and oxygen therapy, patients with bronchospasm may benefit from inhaled bronchodilators, administered by means of a nebulizer metered-dose inhaler. For patients with mild shortness of breath, only supplemental oxygen with a nasal cannula may be required for ventilatory support. Patients who are severely ill and those with signs of respiratory failure, sepsis, and/or neutropenia must be stabilized before transfer.

For patients with bacterial pneumonia, antibiotic therapy is the mainstay of treatment. Empiric therapy for hospitalized patients should initially be broad and cover the likely causative organisms. The possibility of Legionella infection should always be considered when evaluating community-acquired pneumonia, as delayed treatment significantly increases mortality. The most prevalent causative organism is S pneumoniae.

Surgery, medications, and pulmonary rehabilitation

Pulmonologists, as experts in respiratory health, play a crucial role in pulmonary rehabilitation. They work closely with patients and their families to manage the long-term care often required for lung diseases. Pulmonologists coordinate with other healthcare professionals, including respiratory therapists and asthma educators, to provide comprehensive care. Their treatment plans are tailored to individual needs, taking into account the type of pneumonia, the patient's overall health, age, and other factors.

Pulmonologists are highly trained in the respiratory system and can specialise further in areas like critical care, asthma, and sleep medicine. They often collaborate with cardiologists due to the similarities in symptoms between lung and heart conditions. In hospital settings, pulmonologists oversee the care of patients requiring life support or manual ventilation. Their expertise is sought for complex illnesses primarily affecting the lungs, while primary care doctors typically handle milder, short-term respiratory infections.

The treatment methods employed by pulmonologists reflect their specialised knowledge of the respiratory system. Their focus on respiratory health enables them to develop tailored treatment plans, coordinate care with relevant specialists, and guide patients and their families through the often-complex journey of managing long-term lung conditions.

Prevention with vaccinations and healthy habits

Vaccinations and healthy habits can help prevent pneumonia, a serious lung infection. Vaccines cannot prevent all cases of pneumonia, but they can help prevent pneumonia caused by pneumococcus bacteria or the flu virus. Pneumococcal vaccines are especially important for people at high risk of pneumonia, including those with weak immune systems, such as those with cancer, HIV, asthma, or sickle cell disease. Antiviral medication can also be prescribed to treat viral pneumonia.

Good hygiene, such as regular handwashing, is an effective way to prevent pneumonia. This is because handwashing kills germs, including the bacteria and viruses that cause pneumonia. Quitting smoking is another way to lower your risk of pneumonia. Smoking damages your lungs' ability to filter out and defend against germs.

To keep your immune system strong, get plenty of physical activity and eat healthily. A healthy immune system helps your body fight off infection. Drinking plenty of fluids can also help prevent pneumonia by loosening secretions and bringing up phlegm.

Frequently asked questions