Community Acquired Pneumonia
How is it treated?
Treatment for CAP varies according to the organism responsible for the infection. If the cause is bacterial, then the goal of treatment is to cure the infection with antibiotics, which can typically be taken orally at home if the infection is not severe. However, if the infection is severe, the person is having a lot of difficulty breathing, or has other chronic medical conditions, then antibiotics should be given intravenously (into a vein) at a health facility such as a hospital. If the infection is caused by a virus, then treatment with antibiotics would not be effective because antibiotics only help eliminate bacteria,. In this type of situation, supportive care should be administered which might include using acetaminophen to reduce fever or provide oxygen therapy to help with breathing.
Because several treatment guidelines are available, the specific drug(s) that your doctor may use to treat your CAP may vary. Clinical expertise/preference and antibiotic drug resistance in a particular setting are two factors that may affect a doctor?s drug of choice for treating CAP.
At the initial visit to the doctor, he or she will question you about your past medical history and perform a physical examination. It may be necessary to perform a chest X-ray. Next, your doctor will determine how much your infection places your life at risk. Your doctor may need to send samples of your sputum, blood or urine to the laboratory to confirm your CAP diagnosis. Due to that fact that identifying the exact cause of your infection may take several days, doctors will prescribe "empiric therapy" by using their clinical expertise. This kind of treatment is based on the most likely cause of the infection (bacteria, virus, or fungi) and allows for treatment to begin as soon as possible. Once the organism is identified, therapy can be tailored to treat that specific organism. The following chart describes the guidelines from the Infectious Diseases Society of America and American Thoracic Society for patients that do not require hospitalization.
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Patient Variables
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Treatment Options
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Healthy Patients who HAVE NOT had recent antibiotic therapy taken within the last 3 months
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- A macrolide, such as azithromycin (Zithromax), clarithromycin (Biaxin) or erythromycin, or
doxycycline.
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Patients with other health problems (eg. COPD, diabetes, heart failure, or cancer) or who HAVE had recent antibiotic therapy taken within the last 3 months*
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- A respiratory fluoroquinolone, such as levofloxacin (Levaquin), gemifloxacin (Factive), moxifloxacin (Avelox)
- A macrolide or doxycycline plus high-dose amoxicillin (e.g., 1000mg three times daily), high-dose amoxicillin-clavulanate (Augmentin), ceftriaxone (Rocephin), cefpodoxime (Vantin), cefdinir (Omnicef), or cefuroxime (Ceftin)
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*For patients who HAVE had recent antibiotic therapy within the last 3 months, an alternative antibiotic from a different class should be selected. For example, if a fluoroquinolone such as levofloxacin was taken within the last 3 months, a combination of a macrolide or doxycyline plus high-dose amoxicillin, amoxicillin clavulanate, ceftriaxone, cefpodoxime, or cefuroxime should be used to treat the current pneumonia.
When CAP patients require hospitalization, IV antibiotics will generally be initiated along with oxygen therapy to help breathing.
Studies have shown that bacterial CAP can effectively be treated with 5 to 14 days of antibiotics. However, this duration of therapy may be longer if the cause of the infection is found to be from specific bacterial organisms such as Legionella or Pseudomonas, fungal organisms, or if you have other medical conditions that may compromise your recovery. Regardless of the drug chosen, it is important to remember to take the entire antibiotic prescribed by your physician. Many people take their medication only until they feel better. This can contribute to antibiotic resistance and allow an infection to recur with even greater severity in the near future. Development of resistance can also have the potential to prevent a given antibiotic from working well to treat other patients with the same infection in your family or community.
Drug classes used to treat Community Acquired Pneumonia Cephalosporins Macrolides Penicillins Quinolones Tetracyclines
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How is it treated?
