Monday, February, 13, 2012

Pneumonia - Treatment

Table of Contents

Home care may be possible, even in severe cases, when there is good support and available home nursing services. Often, caregivers can even be trained to administer intravenous antibiotics and chest therapy to patients at home.

Home Treatment

The following tips are suggested:

  • Drink plenty of liquids (1 - 2 quarts daily).
  • Take oral temperature several times a day. Call your doctor if it does not come down with treatment.
  • Do not suppress a cough. Coughing is an important reflex for clearing the lungs. Some doctors advise taking expectorants, such as guaifenesin (Breonesin, Glycotuss, Glytuss, Hytuss, Naldecon Senior EX, Robitussin) to loosen mucus. However, there is no proof that any of these products make much difference in a patient's outcome.
  • Mild pain can be treated with aspirin (in adults only), acetaminophen (Tylenol), or ibuprofen (Advil, Motrin).
  • For severe pain, codeine or another stronger pain reliever may be prescribed. It should be noted, however, that codeine and other narcotics suppress coughing, so they should be used with care in pneumonia. Such pain relievers often require monitoring.
  • Finish entire course of antibiotics.
  • Don't smoke.

Hospitalization Guidelines

Treatment. If the pneumonia is severe enough for hospitalization, the standard treatment is intravenous antibiotics for 5 - 8 days. In cases of uncomplicated pneumonia, many patients may need only 2 or 3 days of intravenous antibiotics followed by oral therapy. Antibiotics taken by mouth are prescribed when the patient has improved substantially or leaves the hospital.

ITSA/ATS guidelines recommend that patients admitted to the hospital (but not the ICU) be treated with fluoroquinolones or a beta-lactam plus a macrolide (preferably cefotaxime or ceftriaxone and ampicillin).

Duration of Stay. Patients should remain in the hospital until all their vital signs are stable. Most patients become stabilized in 3 days and can continue treatment at home. Many experts use seven variables to measure stability and to determine whether the patient can go home:

  • Temperature. Some experts believe that patients can go home when their temperature drops to 101 °F. Stricter criteria require that it be at or close to 98.6 °F.
  • Respiration rate. Goal is a normal breathing rate, although expert opinion differs on the degree of normality required for discharge.
  • Heart rate. Goal is 100 beats per minute or less.
  • Blood pressure. Goal is systolic blood pressure of 90 mmHg or greater.
  • Oxygenation. Goal is determined by the physician.
  • The ability to eat. Goal is regular appetite.
  • Mental function. Goal is normal.

Patients or their families should discuss these criteria with their doctor.

Review Date: 04/13/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)