Medicines for Pneumonia

What it is

Pneumonia is an infection that inflames the alveoli, the tiny air sacs deep in the lungs where oxygen passes into the blood. As the sacs fill with fluid and inflammatory cells, breathing becomes harder and the lungs work less well. Typical features are a cough — often bringing up phlegm — fever, shivering, breathlessness, a fast heartbeat, feeling generally unwell, and a sharp chest pain that is worse when breathing in or coughing. In older or frail people the picture can be less obvious, sometimes showing mainly as confusion, drowsiness or a fall rather than the classic symptoms. Most cases caught in the community are bacterial, with the pneumococcus (Streptococcus pneumoniae) the commonest cause, although viruses and so-called atypical bacteria also play a part. Pneumonia is usually described as community-acquired, when it develops outside hospital, or hospital-acquired, when it starts during or shortly after a hospital stay; the likely organisms — and so the choice of treatment — differ between the two. The very young, the elderly, and people with long-term lung, heart, liver or kidney disease, diabetes, a weakened immune system, or who smoke are at higher risk of getting pneumonia and of becoming seriously unwell with it.

How it is treated

Pneumonia is treated according to how unwell the person is and where the infection was acquired. Doctors assess severity clinically — taking account of breathing rate, blood pressure, oxygen levels, confusion, age and other illnesses — to decide whether someone can be treated at home or needs hospital, and how broad the antibiotics should be. For most community-acquired cases that are mild and managed at home, a single, well-established antibiotic taken by mouth is the mainstay, with a penicillin such as amoxicillin used first-line for most people. A macrolide may be added, or used instead, where an atypical organism is suspected or where the person is allergic to penicillin. More severe pneumonia, or hospital-acquired infection, is treated with broader or combination antibiotics, often given into a vein at first, sometimes including a cephalosporin, alongside oxygen and other supportive care; treatment is then narrowed once the response and any test results are known. Alongside antibiotics, rest, fluids and simple measures for fever and pain help recovery, and oxygen is given if levels are low. Response is reviewed, and people who are not improving as expected are reassessed. Prevention matters too: the pneumococcal and flu vaccines reduce the risk of pneumonia in those for whom they are recommended, and stopping smoking lowers risk.