Treatment:

Your doctor must first decide whether you need to be in the hospital. If you are treated in the hospital, you will receive fluids and antibiotics in your veins, oxygen therapy, and possibly breathing treatments. It is very important that your antibiotics are started very soon after you are admitted.

You are more likely to be admitted to the hospital if you:

• Have another serious medical problem
• Have severe symptoms
• Are unable to care for yourself at home, or are unable to eat or drink
• Are older than 65 or a young child
• Have been taking antibiotics at home and are not getting better

However, many people can be treated at home. If bacteria are causing the pneumonia, the doctor will try to cure the infection with antibiotics. It may be hard for your health care provider to know whether you have a viral or bacterial pneumonia, so you may receive antibiotics.

Patients with mild pneumonia who are otherwise healthy are sometimes treated with oral macrolide antibiotics (azithromycin, clarithromycin, or erythromycin).

Patients with other serious illnesses, such as heart disease, chronic obstructive pulmonary disease, or emphysema, kidney disease, or diabetes are often given one of the following:

• Fluoroquinolone (levofloxacin (Levaquin), sparfloxacin (Zagam), gemifloxacin (Factive), or moxifloxacin (Avelox)
• High-dose amoxicillin or amoxicillin-clavulanate, plus a macrolide antibiotic (azithromycin, clarithromycin, or erythromycin)
• Cephalosporin antibiotics (for example, cefuroxime or cefpodoxime) plus a macrolide (azithromycin, clarithromycin, or erythromycin)

If the cause is a virus, typical antibiotics will NOT be effective. Sometimes, however, your doctor may use antiviral medication.

You can take these steps at home:

• Drink plenty of fluids to help loosen secretions and bring up phlegm.
• Get lots of rest. Have someone else do household chores.
• Do not take cough medicines without first talking to your doctor. Cough medicines may make it harder for your body to cough up the extra sputum.
• Control your fever with aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen or naproxen), or acetaminophen. DO NOT give aspirin to children.

Expectations (prognosis):

With treatment, most patients will improve within 2 weeks. Elderly or debilitated patients may need longer treatment.

Those who may be more likely to have complicated pneumonia include:

• Older adults or very young children
• People whose immune system does not work well
• People with other, serious medical problems such as diabetes or cirrhosis of the liver

Your doctor may want to make sure your chest x-ray becomes normal again after you take a course of antibiotics. However, it may take many weeks for your x-ray to clear up.

Complications:

Possible complications include:

• Respiratory failure, which requires a breathing machine or ventilator
• Empyema or lung abscesses. These are infrequent, but serious, complications of pneumonia. They occur when pockets of pus form inside or around the lung. These may sometimes need to be drained with surgery.
• Sepsis, a condition in which there is uncontrolled swelling (inflammation) in the body, which may lead to organ failure
• Acute respiratory distress syndrome (ARDS), a severe form of respiratory failure

Calling your health care provider:

Call your doctor if you have:

• Worsening respiratory symptoms
• Shortness of breath, shaking chills, or persistent fevers
• Rapid or painful breathing
• A cough that brings up bloody or rust-colored mucus
• Chest pain that worsens when you cough or inhale
• Night sweats or unexplained weight loss
• Signs of pneumonia and weak immune system, as with HIV or chemotherapy

Infants with pneumonia may not have a cough. Call your doctor if your infant makes grunting noises or the area below the rib cage is retracting while breathing.