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Pneumonia
Pneumonia
Bronchopneumonia; Community-
acquired pneumonia
Last reviewed: April 27, 2010.
Pneumonia is a respiratory condition
in which there is infection of the
lung.
Community-acquired pneumonia
refers to pneumonia in people who
have not recently been in the
hospital or another health care
facility (nursing home, rehabilitation
facility).
See also: Hospital-acquired
pneumonia
Causes, incidence, and risk
factors
Pneumonia is a common illness that
affects millions of people each year
in the United States. Germs called
bacteria, viruses, and fungi may
cause pneumonia.
Ways you can get pneumonia
include:
• Bacteria and viruses living in
your nose, sinuses, or mouth
may spread to your lungs.
• You may breathe some of
these germs directly into your
lungs.
• You breathe in (inhale) food,
liquids, vomit, or secretions
from the mouth into your lungs
(aspiration pneumonia)
Pneumonia caused by bacteria tends
to be the most serious. In adults,
bacteria are the most common cause
of pneumonia.
• The most common pneumonia-
causing germ in adults
is Streptococcus
pneumoniae (pneumococcus).
• Atypical pneumonia, often
called walking pneumonia, is
caused by bacteria such
as Legionella
pneumophila, Mycoplasma
pneumoniae ,
and Chlamydophila
pneumoniae.
• Pneumocystis
jiroveci pneumonia is
sometimes seen in people
whose immune system is
impaired (due to AIDS or
certain medications that
suppress the immune system).
• Staphylococcus
aureus, Moraxella
 catarrhalis, Streptococcus
pyogenes, Neisseria
meningitidis, Klebsiella
pneumoniae, orHaemophilus
influenzae are other bacteria
that can cause pneumonia.
• Tuberculosis can cause
pneumonia in some people,
especially those with a weak
immune system.
Viruses are also a common cause of
pneumonia, especially in infants and
young children.
See also: Respiratory syncytial virus
Risk factors (conditions that increase
your chances of getting pneumonia)
include:
• Cerebral palsy
• Chronic lung disease
(COPD, bronchiectasis, cystic
fibrosis)
• Cigarette smoking
 • Difficulty swallowing (due
to stroke, dementia, Parkinson'
s disease, or other
neurological conditions)
• Immune system problem (See
also: Pneumonia in
immunocompromised host)
• Impaired consciousness (loss
of brain function due to
dementia, stroke, or other
neurologic conditions)
• Living in a nursing facility
• Other serious illnesses, such
as heart disease,
liver cirrhosis, or diabetes
mellitus
• Recent surgery or trauma
Recent viral respiratory
•

infection (common
cold, laryngitis, influenza)
Symptoms
The most common symptoms of
pneumonia are:
 • Cough (with some pneumonias
you may cough up greenish or
yellow mucus, or even bloody
mucus)
• Fever, which may be mild or
high
• Shaking chills
• Shortness of breath (may only
occur when you climb stairs)
Additional symptoms include:
• Confusion, especially in older
people
• Excessive sweating and
clammy skin
• Headache
• Loss of appetite, low energy,
and fatigue
• Sharp or stabbing chest pain
that gets worse when you
breathe deeply or cough
Signs and tests
If you have pneumonia, you may be
working hard to breathe, or
breathing fast.
Crackles are heard when listening to
your chest with a stethoscope. Other
abnormal breathing sounds may also
be heard through the stethoscope or
via percussion (tapping on your
chest wall).
The health care provider will likely
order a chest x-ray if pneumonia is
suspected.
Some patients may need other tests,
including:
• Arterial blood gases to see if
enough oxygen is getting into
your blood from the lungs
• CBC to check white blood cell
count
• CT scan of the chest
• Gram's stain and culture of
your sputum to look for the
 organism causing your
symptoms
• Pleural fluid culture if there is

fluid in the space surrounding

the lungs
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], gemif

loxacin [Factive],
or moxifloxacin [Avelox])
• High-dose amoxicillin or amoxi

cillin-clavulanate, plus a
macrolide antibiotic
(azithromycin, clarithromycin,
or erythromycin)
• Cephalosporin antibiotics (for

example, cefuroxime or cefpod

oxime) plus a macrolide
(azithromycin, clarithromycin,
orerythromycin)
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:
• Control your fever with aspirin,
nonsteroidal anti-inflammatory
drugs (NSAIDs, such
 as ibuprofen or naproxen),
oracetaminophen. DO NOT
give aspirin to children.
• 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.
• Drink plenty of fluids to help
loosen secretions and bring up
phlegm.
• Get lots of rest. Have someone
else do household chores.
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:
• Acute respiratory distress
syndrome (ARDS), a severe
form of respiratory failure
• 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.
• Respiratory failure, which
requires a breathing machine
or ventilator
•Sepsis, a condition in which
there is uncontrolled swelling
(inflammation) in the body,
which may lead to organ
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.
Prevention
Wash your hands frequently,
especially after blowing your nose,
going to the bathroom, diapering,
and before eating or preparing
foods.
Don't smoke. Tobacco damages your
lung's ability to ward off infection.
Vaccines may help prevent
pneumonia in children, the elderly,
and people with diabetes, asthma,
emphysema, HIV, cancer, or other
chronic conditions:
• A drug called Synagis
(palivizumab) is given to some
children younger than 24
months to prevent pneumonia
caused byrespiratory syncytial
virus.
• Flu vaccine prevents
pneumonia and other
problems caused by the
influenza virus. It must be
given yearly to protect against
new virus strains.
• Hib vaccine prevents
pneumonia in children
from Haemophilus
influenzae type b.
• Pneumococcal
vaccine (Pneumovax, Prevnar)
lowers your chances of getting
pneumonia
 from Streptococcus
pneumoniae.
If you have cancer or HIV, talk to
your doctor about additional ways to
prevent pneumonia and other
infections.
References
1. Higgins K, Singer M, Valappil T,
Nambiar S, Lin D, Cox E.
Overview of recent studies of
community-acquired
pneumonia. Clin Infect Dis.
2008;47:S150-156. [PubMed]
2. Van der Poll T, Opal SM.
Pathogenesis, treatment, and
prevention of pneumococcal
pneumonia. Lancet.
2009;374:1543-1556.
[PubMed]
3. Recommended Childhood and
Adolescent Immunization
Schedules -- United States,
2010. Committee on Infectious
 Diseases.Pediatrics.
2010;125:195-196.
4. Advisory Committee on
Immunization Practices.
Recommended adult
immunization schedule: United
States, 2010. Ann Intern Med.
2010. 152:36-39.
5. Li JZ, Winston LG, Moore DH,
Bent S. Efficacy of short-course
antibiotic regimens for
community-acquired
pneumonia: a meta-
analysis. Am J Med.
2007;120:783-790. [PubMed]
6. Mandell LA, Wunderink RG,
Anzueto A, et al. Infectious
Diseases Society of
America/American Thoracic
Society consensus guidelines
on the management of
community-acquired
pneumonia in adults. Clin
 Infect Dis. 2007 Mar 1;44
Suppl 2:S27-72. [PubMed]
Review Date: 4/27/2010.
Reviewed by: Allen J. Blaivas,
DO, Clinical Assistant Professor
of Medicine, UMDNJ-NJMS,
Attending Physician in the
Division of Pulmonary, Critical
Care, and Sleep Medicine,
Department of Veteran Affairs,
VA New Jersey Health Care
System, East Orange, NJ. Review
provided by VeriMed Healthcare
Network. Also reviewed by David
Zieve, MD, MHA, Medical
Director, A.D.A.M., Inc.

A.D.A.M., Disclaimer
Copyright © 2011, A.D.A.M., Inc.
In this Page
• Causes, incidence, and risk factors

• Symptoms
• Signs and tests
• Treatment
• Expectations (prognosis)
• Complications
• Calling your health care provider
• Prevention
• References
Figures

• Pneumococci organism

• Lungs

• Pneumonia

• White nail syndrome

• Pneumococcal pneumonia
• Respiratory system
Read More
• Mycoplasma pneumonia

• Flu

• Aspiration pneumonia

• Atypical pneumonia

• CMV - pneumonia

• Hospital-acquired pneumonia

• Legionnaire's disease

• Pneumocystis jiroveci pneumonia

• Pneumonia - weakened immune

system
• Viral pneumonia

• Empyema

• Avian influenza

•
• Pneumonia
• MedlinePlus.gov links to free,
reliable, up-to-date health
information from the National
 Institutes of Health (NIH) and other
trusted health organizations.
Evaluating your options
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This guide can help you work with
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the joints. No treatment can cure RA.
But the drugs in this guide can slow
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better. This guide is based on a
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research about RA medicines.
Besides helping you learn about
what happens with RA, this guide
explains the benefits, risks, and
costs of RA drugs.
• Comparing Targeted Immune

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How do targeted immune modulators
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Drugs of interest
• Erythromycin

Erythromycin is an antibiotic used to

treat certain infections caused by
bacteria, such as bronchitis;
diphtheria; Legionnaires' disease;
pertussis (whooping cough);
pneumonia; rheumatic fever;
venereal disease (VD); and ear,
intestine, lung, urinary tract, and
skin infections. It is also used before
some surgery or dental work to
prevent infection. Antibiotics will not
work for colds, flu, or other viral
infections. This medication is
sometimes prescribed for other uses;
ask your doctor or pharmacist for
more information.
• Levofloxacin

Levofloxacin is used to treat certain

infections such as pneumonia
chronic bronchitis and sinus, urinary
 tract, kidney, prostate (a male
reproductive gland), and skin
infections. Levofloxacin is also used
to prevent anthrax (a serious
infection that may be spread on
purpose as part of a bioterror attack)
in people who may have been
exposed to anthrax germs in the air.
Levofloxacin is in a class of
antibiotics called fluoroquinolones. It
works by killing bacteria that cause
infections. Antibiotics will not work
for colds, flu, or other viral
infections.
• Amoxicillin

Amoxicillin is used to treat certain

infections caused by bacteria, such
as pneumonia; bronchitis;
gonorrhea; and infections of the
ears, nose, throat, urinary tract, and
skin. It is also used in combination
with other medications to eliminate
H. pylori, a bacteria that causes
ulcers. Amoxicillin is in a class of
 medications called penicillin-like
antibiotics. It works by stopping the
growth of bacteria. Antibiotics will
not work for colds, flu, and other
viral infections.
• Azithromycin

Azithromycin is used to treat certain

infections caused by bacteria, such
as bronchitis; pneumonia; sexually
transmitted diseases (STD); and
infections of the ears, lungs, skin,
and throat. Azithromycin is in a class
of medications called macrolide
antibiotics. It works by stopping the
growth of bacteria. Antibiotics will
not work for colds, flu, or other viral
infections.
• Clarithromycin

Clarithromycin is used to treat

certain infections caused by
bacteria, such as pneumonia (a lung
infection), bronchitis (infection of the
tubes leading to the lungs), and
infections of the ears, sinuses, skin,
and throat. It also is used to treat
and prevent disseminated
Mycobacterium avium complex
(MAC) infection [a type of lung
infection that often affects people
with human immunodeficiency virus
(HIV)]. It is used in combination with
other medications to eliminate H.
pylori, a bacteria that causes ulcers.
Clarithromycin is in a class of
medications called macrolide
antibiotics. It works by stopping the
growth of bacteria. Antibiotics will
not work for colds, flu, or other viral
infections.
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