Supportive Care and Treatment for Pneumonia

General Supportive Care

• The British Thoracic Society recommends that patients with pneumonia rest and avoid smoking 1
• The British Thoracic Society suggests encouraging adequate fluid intake to maintain hydration in patients with pneumonia 1
• The British Thoracic Society advises providing simple analgesia such as paracetamol for pleuritic pain in patients with pneumonia 1
• The British Thoracic Society recommends considering nutritional supplements for patients with prolonged illness 1
• The British Thoracic Society suggests regular reassessment after 48 hours or earlier if clinically indicated in patients with pneumonia 1
• The British Thoracic Society recommends using pulse oximetry to assess severity and oxygen requirements in patients with pneumonia 1
• The British Thoracic Society advises providing appropriate oxygen therapy with monitoring of oxygen saturations and FiO2, aiming to maintain PaO2 >8 kPa and SaO2 >92% in hospitalized patients with pneumonia 1, 2
• The British Thoracic Society recommends assessing for volume depletion and providing intravenous fluids as needed in hospitalized patients with pneumonia 1, 2
• The British Thoracic Society suggests providing nutritional support, especially in prolonged illness, in hospitalized patients with pneumonia 1, 3
• The British Thoracic Society advises monitoring vital signs (temperature, respiratory rate, pulse, blood pressure, mental status, oxygen saturation) at least twice daily, more frequently in severe cases, in hospitalized patients with pneumonia 1, 2

Antibiotic Therapy

• The British Thoracic Society recommends amoxicillin as the preferred agent for community-managed pneumonia 1, 2
• The British Thoracic Society suggests a macrolide (erythromycin or clarithromycin) as an alternative choice, especially for patients with penicillin hypersensitivity 1
• The British Thoracic Society advises considering immediate antibiotic administration if the illness is life-threatening or if hospital admission may be delayed in patients with suspected severe pneumonia 1
• The British Thoracic Society recommends oral route for non-severe pneumonia in hospitalized patients if no contraindications exist 4
• The British Thoracic Society suggests switching from parenteral to oral antibiotics as soon as clinical improvement occurs and temperature has been normal for 24 hours in hospitalized patients with non-severe pneumonia 4
• The British Thoracic Society recommends treatment duration of 7 days for uncomplicated cases of pneumonia 4
• The British Thoracic Society advises immediate treatment with parenteral antibiotics after diagnosis in hospitalized patients with severe pneumonia 4
• The British Thoracic Society recommends combination therapy with a broad-spectrum β-lactamase stable antibiotic plus a macrolide for hospitalized patients with severe pneumonia 4
• The Infectious Diseases Society of America recommends β-lactams (amoxicillin, cefotaxime, and ceftriaxone) as the drugs of choice for community-acquired pneumonia due to Streptococcus pneumoniae 5
• The Military Medical Research journal suggests empirical antibiotics should target suspected potential infections, avoiding blind or improper combinations of broad-spectrum antibiotics, in patients with COVID-19 pneumonia 6

Advanced Respiratory Support for Severe Pneumonia

• The Military Medical Research journal recommends considering high-flow nasal oxygen (HFNO) when standard oxygen therapy fails to maintain SpO2 above 93% with rapidly increasing breathing rate in patients with severe pneumonia 7
• The Military Medical Research journal suggests non-invasive ventilation (NIV) may be useful to reduce respiratory power consumption and improve oxygenation in patients with severe pneumonia 7
• The Military Medical Research journal advises implementing invasive mechanical ventilation if ARDS persists or acutely deteriorates despite HFNO or NIV in patients with severe pneumonia 7
• The Military Medical Research journal recommends using a protective lung ventilation strategy with lower tidal volume (4-6 ml/kg), lower plateau pressure (<30 cmH2O), and appropriate PEEP in patients with severe pneumonia 7

Management of Complications

• The Military Medical Research journal recommends recognizing septic shock early (infection with need for vasoconstrictors to maintain MAP ≥65 mmHg with lactate ≥2 mmol/L despite fluid resuscitation) in patients with pneumonia 6
• The Military Medical Research journal advises providing at least 30 ml/kg of isotonic crystalloid for adults in the first 3 hours of septic shock treatment 6
• The Military Medical Research journal recommends administering vasoconstrictors when shock persists after fluid resuscitation, with noradrenaline as first choice, in patients with septic shock 6

Prevention

• The British Thoracic Society recommends influenza vaccination for high-risk groups including those with chronic lung, heart, renal and liver disease, diabetes mellitus, immunosuppression, and those aged over 65 years 4
• The British Thoracic Society advises pneumococcal vaccination for those aged 2 years or older in whom pneumococcal infection is likely to be more common or serious 4