Let’s Talk About Pneumonia Treatment
This lung infection can take your breath away, literally. But with the right therapies, your chances of recovery are excellent.
Coughing, chills, chest pain, fatigue—if you’re experiencing pneumonia, nothing feels easy and there’s a lot that feels scary. The good news: There are treatments that work, and once you start them, you’ll likely begin feeling better within several days (though full recovery can take a while). Here’s what to know about the medications, self-care measures, and other therapies that can get you breathing easy again.
Our Pro Panel
We went to some of the nation’s top experts in lung disorders and infectious diseases to bring you the most scientific and up-to-date information available.
Michael Gutwein, M.D.
Chief Emeritus, Infectious Disease Division
Missouri Baptist Medical Center
St. Louis, MO
Jeffrey Pernica, M.D.
Head, Division of Infectious Diseases and Associate Professor, Department of Pediatrics
Rachel Scheraga, M.D.
Assistant Professor of Medicine and Associate Staff Physician, Pulmonology and Critical Care Medicine
If the pneumonia is bacterial (or likely bacterial), yes. If it’s viral, no—but even if your doctor suspects you have viral pneumonia (or it’s confirmed via, say, an influenza test), you’ll probably be prescribed antibiotics anyway, at least initially, since it’s possible to have viral and bacterial pneumonia concurrently. Plus, having viral pneumonia puts you at risk of later developing “secondary” bacterial pneumonia.
It might carry on for up to six weeks after the infection itself is cleared up. If it’s really bad (keeping you up at night), talk to your doctor; he or she may recommend a prescription cough medication to use temporarily.
Yes, usually. If you have pneumonia, you’re considered contagious until you’ve been on antibiotics for two days and don’t have a fever (for bacterial pneumonia), or until you feel better and have been fever-free for several days (viral pneumonia).
In addition to taking your prescribed meds and following your doctor’s instructions, get lots of rest, stay hydrated (no alcohol!), use a humidifier or inhale steam from a bath or shower to loosen phlegm, and drink hot herbal tea or hot water with lemon and honey to ease coughing or soothe an irritated throat. An over-the-counter pain reliever like Tylenol (acetaminophen) or Advil (ibuprofen) can help relieve fever or aches while you recover.
Remind Me, What Is Pneumonia?
In the simplest terms, pneumonia is an infection in your lungs—specifically, the air sacs, or alveoli, and the lung tissue that surrounds them. It’s usually caused by either a virus or bacteria (or sometimes, both; this is called “co-infection”). Pneumonia can occur in people of any age, but it is most common—and dangerous—in those over 65 and very young children.
To understand pneumonia, it helps to know the basics of how your lungs function normally. Each of your lungs has a main tube, called a bronchus (plural bronchi), that carries air into it from your windpipe, or trachea. Each bronchus branches off into progressively smaller bronchi, which in turn split off into thousands of even smaller airways called bronchioles. At the end of the bronchioles are millions (yes, millions) of tiny air sacs called alveoli. Your alveoli are covered with very small blood vessels called capillaries that are responsible for transporting oxygen from the alveoli to the cells of your body and returning carbon dioxide, which you then exhale.
When you have pneumonia, though, an immune response to the infection in your lungs causes the alveoli to fill up with fluid or pus and the airways to become inflamed and swollen. This in turn limits the amount of oxygen that can get to your bloodstream and therefore to your body’s organs, leading to symptoms that can range from mild to severe or even life-threatening (pre-COVID, pneumonia was the ninth leading cause of death in the United States, killing about 50,000 people annually; numbers have risen during COVID). In mild cases, though, you may barely notice your symptoms, something experts refer to as “walking pneumonia.”
If you do show symptoms of pneumonia, the hallmarks are chest pain, cough, fever, and shortness of breath. These are a few common red flags for the condition that you can expect:
Chest pain. This is usually sharp or stabbing and may worsen when you breathe in or cough.
Chills, possibly with shaking.
Cough. The cough might be dry (more common in viral pneumonia), or it may be “productive,” bringing up phlegm that’s green, yellowish-tan, or bloody (characteristic of bacterial pneumonia).
Fever. Temperatures can range from just over 100°F to 105°F.
Headache. This is more common in viral pneumonia, early in the infection.
Mental confusion. If you’re over 65, this symptom is more common.
Muscle pain. You’re likely to feel this early on in a viral pneumonia infection.
Rapid breathing and/or rapid heart rate. This symptom occurs most often in younger adults and children.
Shortness of breath.
Weakness and fatigue.
How Can You Tell If It’s Definitely Pneumonia?
You may have noticed that many symptoms on the list above are similar to those of other respiratory infections, like the flu (influenza), a bad cold, bronchitis, or COVID-19. And all of those illnesses can also be a cause of pneumonia themselves. So how do you know which one(s) you have? The only way to find out is to see a medical pro. It can be especially hard to distinguish pneumonia from other illnesses if your infection is viral and it’s early on in the illness. As long as COVID is circulating, you’ll probably need to get a COVID test to rule out the SARS-CoV-2 (COVID-19) virus as the cause of your symptoms. If it’s flu (influenza) season, you’ll likely get a flu test too.
What Causes Pneumonia?
Pneumonia is caused by tiny germs called microorganisms that get into your lower respiratory tract (that is, your lungs) and multiply. Three main types of microorganisms cause pneumonia: viruses, bacteria, and fungi. The most common by far are viruses and bacteria. You can be exposed to these germs through respiratory droplets in the air or on surfaces that have been touched or coughed or sneezed on by a sick person. Much less commonly, pneumonia can be caused by a fungus (mold) or from breathing in chemical irritants (due to long-term exposure on the job, for example).
You can also get pneumonia by accidentally aspirating, or inhaling, food particles or liquids into your lungs. The particles may be contaminated with microorganisms that can lead to pneumonia. This kind of pneumonia is called aspiration pneumonia. It’s not contagious, but it can be very dangerous. In addition, several other risk factors can raise your chances of getting pneumonia. They include:
Difficulty swallowing (dysphagia) or coughing
Having an underlying lung condition such as asthma, chronic obstructive pulmonary disease (COPD), or cystic fibrosis
Having another chronic medical condition, including heart disease, kidney disease, sickle cell anemia, type 2 diabetes, or cancer
Heavy alcohol use or alcoholism
Living in a nursing home or other long-term care facility
A recent major surgery or injury
A recent viral respiratory illness such as the common cold, flu, or COVID-19
Once your doc has determined that you have pneumonia (using a physical exam, X-ray, and blood test, as well as eliminating COVID-19 through a COVID test), the best treatment depends on what the doctor suspects is causing it. The treatment approach will also take into account how sick you are and if you have underlying conditions (like heart or lung disease or diabetes) that make you more vulnerable to pneumonia complications.
Most people can recover from this illness within one to three weeks with a combination of oral meds, rest, and self-care. If your pneumonia is serious or you have certain risk factors, your doctor might admit you to the hospital so that you can get IV antibiotics and fluids and supplemental (extra) oxygen. Let’s take a closer look at the main treatment types.
These are the mainstay of treatment for bacterial pneumonia, and the truth is that you’re likely to get antibiotics even if the doctor doesn’t know for sure whether your infection is bacterial or viral (which won’t respond to antibiotics). The reason: Lab results can take several days, and meanwhile, someone is sick and needs help.
Oral antibiotics for pneumonia are generally taken one to three times a day, depending on the drug and whether it’s an extended-release (ER) version. If you had pneumonia when you were a kid, you might have received antibiotics for seven to 10 days, but a recent study in JAMA Pediatrics found that children who took a five-day course of amoxicillin recovered comparably to those who took the drug for 10 days. Ask your doctor for guidance on these common antibiotic options:
Amoxicillin: This familiar name is a first-line treatment for adults with pneumonia who don’t have “comorbidities” (i.e. heart, lung, liver, or kidney disease; type 2 diabetes; alcoholism; cancer; or a removed spleen).
Doxycycline: This is a member of a class of antibiotics known as tetracyclines. Like amoxicillin, it’s recommended as a first-line treatment for non-severe pneumonia that doesn’t require hospitalization and isn’t accompanied by one or more of the underlying conditions listed above.
Zithromax (azithromycin) or Biaxin (clarithromycin): These first-line meds belong to a class of antibiotics known as macrolides. Sometimes prescribed in combination with another drug (see below), docs use these on people who have underlying health conditions.
Augmentin (amoxicillin/clavulanate): This drug combines amoxicillin with the drug clavulanate to work against a broader range of bacteria. If you have one of the comorbidities listed above, you might be prescribed Augmentin in combination with either doxycycline or a macrolide.
Vantin (cefpodoxime) or Ceftin (cefuroxime): These two medications belong to an antibiotic class called cephalosporins. Like Augmentin, Vantin or Ceftin might be prescribed in combination with doxycycline or a macrolide if you have an underlying condition.
Fluoroquinolones: As an alternative to combination therapy with Augmentin or a cephalosporin plus another drug, your doctor might prescribe one of the broader-spectrum antibiotics in this class, such as Levaquin (levofloxacin), Avelox (moxifloxacin), or Factive (gemifloxacin).
If your pneumonia is believed to be viral (or partly viral), you might get an antiviral drug like Tamiflu (oseltamivir), also used to treat the flu. Antiviral drugs don’t kill the virus, as antibiotics do with bacteria, but they can sometimes shorten the duration of a viral illness or make symptoms less severe. Tamiflu is taken twice a day for five days. (If you’re diagnosed with COVID-19-related pneumonia, your doctor may try other meds as well.)
Pneumonia caused by a fungus is treated with antifungal drugs, such as Diflucan (fluconazole), or in some cases an antibiotic or antibiotic combination such as Bactrim (trimethoprim/sulfamethoxazole).
In addition to prescription treatments, these steps can help speed your recovery or make you more comfortable while your body fights the infection:
Avoid alcohol and smoking. Alcohol weakens your immunity, while smoking (and exposure to secondhand smoke) can worsen your pneumonia.
Rest. You need extra rest while your body fights the infection.
Inhale moist air. Use a cool-mist humidifier or steam up the bathroom and sit for a while. This can help loosen lung secretions, making your cough more productive.
Soothe your throat. Suck on lozenges or sip hot water with lemon and honey to ease a sore throat. Hold off on over-the-counter cough medicines unless your doctor OK’s them since these can backfire by making your cough less productive.
Stay hydrated. Your body loses water through coughing. Replenish with abundant water and other nonalcoholic beverages.
Take pain relievers as needed. Tylenol (acetaminophen), Advil or Motrin (ibuprofen), Aleve (naproxen), or aspirin can all bring a fever down, plus they’ll help with aches and pains if you’re having them.
Severe Pneumonia Treatment
In cases of serious symptoms or extra-high risk (due to your age or an underlying condition, for instance), your doctor might recommend that you be treated for pneumonia in the hospital. There you can receive intravenous fluids and antibiotics (either orally or through an IV), as well as supplemental (extra) oxygen (a.k.a. oxygen therapy) and breathing treatments as needed. People who are extremely sick with pneumonia might need to be treated in an intensive care unit (ICU) and possibly put on a ventilator.
The groups most likely to be hospitalized for pneumonia are:
Babies and young children
Adults over the age of 65
People with weakened immune systems (due to HIV/AIDS, cancer treatment, or use of immunosuppressive drugs, for example)
People with preexisting heart or lung disease
You might also be hospitalized if you are at risk for a drug-resistant infection with MRSA or Pseudomonas aeruginosa. Both of these germs can cause severe and hard-to-treat pneumonia that is resistant to multiple common antibiotics and therefore has to be treated with very powerful, broad-spectrum drugs that doctors otherwise try not to use.
Is There a Vaccine for Pneumonia?
Of course, the easiest way to treat pneumonia is to never get it in the first place. The pneumococcal vaccine, sometimes called the pneumonia vaccine, can help you do just that. It inoculates you against infection with Pneumococcus (Streptococcus pneumonia), the most common cause of bacterial pneumonia. About 900,000 people in the U.S. get pneumococcal pneumonia each year, according to the CDC, with about 400,000 requiring hospitalization. About 5% to 7% of those hospitalized with pneumococcal pneumonia die from it.
The same bacteria can also cause life-threatening brain infections (meningitis) and bloodstream infections (sepsis). The CDC recommends pneumococcal vaccination for all adults ages 65 and over, all kids under 2, and people who smoke or have certain chronic health conditions. There are two versions of it: Prevnar 13 (PCV13, short for pneumococcal conjugate vaccine) and Pneumovax 23 (PPSV23, short for pneumococcal polysaccharide vaccine). Talk with your doctor about which you should have. For some groups, both vaccines are recommended.
With treatment, you’ll likely start feeling better within a few days, and most people recover fully in two to four weeks (longer on average for bacterial than viral pneumonia, excluding COVID pneumonia).
Keep in mind that having pneumonia once doesn’t make you immune to getting it again. That’s where prevention comes in. The same basic infection-prevention advice that applies to other respiratory infections can also help you ward off pneumonia. After over a year of COVID pandemic life, these steps are probably second nature to you by now:
Wash your hands frequently with soap and water or use hand sanitizer with at least 60 percent alcohol.
Avoid touching your nose, mouth, and eyes unless you’ve just washed or sanitized your hands.
Stay away from people you know are sick.
Don’t smoke; avoid secondhand smoke.
Regularly disinfect “high-touch” surfaces like doorknobs and countertops.
Taking good care of your overall health—including eating well and getting regular exercise—can also help you lower your risk of pneumonia, as can doing what you can to minimize risk factors that apply to you (like quitting smoking if needed, addressing a problem with alcohol, or getting type 2 diabetes under control).
General Info (1.): National Institutes of Health (NIH). (2021.) “Community-Acquired Pneumonia in Adults.” https://medlineplus.gov/ency/article/000145.htm
General Info (2.): National Heart, Lung, and Blood Institute. (n.d.) “Pneumonia.” https://www.nhlbi.nih.gov/health-topics/pneumonia
Pneumonia Symptoms: American Lung Association. (2020.) “Learn About Pneumonia.” https://www.lung.org/lung-health-diseases/lung-disease-lookup/pneumonia/learn-about-pneumonia
Deaths from COVID-related Pneumonia: National Center for Health Statistics. (2021.) “Daily Updates of Totals by Week and State.” https://www.cdc.gov/nchs/nvss/vsrr/covid19/index.htm
Viral Pneumonia: National Institutes of Health. (n.d.) “Viral Pneumonia.” https://medlineplus.gov/ency/article/000073.htm
Pneumonia and COVID-19: Annals of Internal Medicine. (2020.) “Treatment of Community-Acquired Pneumonia During the Coronavirus Disease 2019 (COVID-19) Pandemic.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7236892/
Bacterial and Fungal Pneumonia: National Institutes of Health. (2015.) “Pneumonia.” https://medlineplus.gov/pneumonia.html
Smoking and Pneumonia: PLoS One. (2019.) “Effect of tobacco smoking on the risk of developing community acquired pneumonia: A systematic review and meta-analysis.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6638981/
Pneumonia Diagnosis and Treatment (1.): American Thoracic Society and Infectious Diseases Society of America. (2019.) “Diagnosis and Treatment of Adults with Community-Acquired Pneumonia.” https://www.atsjournals.org/doi/pdf/10.1164/rccm.201908-1581ST
Pneumonia Diagnosis and Treatment (2.): American Family Physician. (2016.) “Community-Acquired Pneumonia in Adults: Diagnosis and Management.” https://www.aafp.org/afp/2016/1101/p698.html
Duration of Antibiotic Treatment: JAMA Pediatrics. (2021.) “Short-Course Antimicrobial Therapy for Pediatric Community-Acquired Pneumonia: The SAFER Randomized Clinical Trial.” https://jamanetwork.com/journals/jamapediatrics/article-abstract/2776976
Doxycycline: National Institutes of Health. (2017.) “Doxycycline.” https://medlineplus.gov/druginfo/meds/a682063.html
Zithromax (azithromycin): National Institutes of Health. (n.d.) “Zithromax.” https://medlineplus.gov/druginfo/meds/a697037.html
Ceftin (cefuroxamine): Mayo Clinic. (2021.) “Drugs and Supplements: Cefuroxamine (Oral Route).” https://www.mayoclinic.org/drugs-supplements/cefuroxime-oral-route/description/drg-20073295
Vantin (cefpodoxime): Mayo Clinic. (2021.) “Drugs and Supplements: Cefpodoxime (Oral Route).” https://www.mayoclinic.org/drugs-supplements/cefpodoxime-oral-route/description/drg-20073381
Levaquin (levofloxacin): Mayo Clinic. (2021.) “Drugs and Supplements: Levofloxacin (Oral Route).” https://www.mayoclinic.org/drugs-supplements/levofloxacin-oral-route/description/drg-20064518
Factive (gemifloxacin): Mayo Clinic. (2021.) “Drugs and Supplements: Gemifloxacin (Oral Route).” https://www.mayoclinic.org/drugs-supplements/gemifloxacin-oral-route/description/drg-20064025
Avelox (moxifloxacin): Mayo Clinic. (2021.) “Drugs and Supplements: Moxifloxacin (Oral Route).” https://www.mayoclinic.org/drugs-supplements/moxifloxacin-oral-route/description/drg-20072313
Tamiflu (oseltamivir): National Institutes of Health. (2018.) “Oseltamivir.” https://medlineplus.gov/druginfo/meds/a699040.html#how
Hospitalization: American Academy of Family Physicians. (2020.) “Pneumonia.” https://familydoctor.org/condition/pneumonia/
Methicillin-resistant Staphylococcus aureus (MRSA): Centers for Disease Control and Prevention. (2019.) “Methicillin-resistant Staphylococcus aureus.” https://www.cdc.gov/mrsa/index.html
Pneumonia (Pneumococcal) Vaccine: Centers for Disease Control and Prevention. (2019.) “Pneumococcal Vaccination.” https://www.cdc.gov/vaccines/vpd/pneumo/index.html