Bacterial pneumonia treatment. Best antibiotic for pneumonia

Bacterial pneumonia treatment

What is bacterial pneumonia?

A bacterial pneumonia is an acute infectious inflammatory process in the pulmonary tissue. It appears as a result of the entry of the pathogenic organisms into the lungs. This disease is dangerous because it induces an intoxication and a severe fever. If the treatment is delayed, the bacterial pneumonia leads to the disorder of the respiratory function.

What is bacterial pneumonia?

According to the WHO statistics:

  • 16% of all fatal outcomes among children at the age of 5 falls to the bacterial pneumonia;
  • Up to 120 million cases of the pneumonia are registered every year in the world;
  • Every fifth patient with pneumonia is a child at the age of under 5;
  • About 10% of patients have a severe type of the bacterial pneumonia;
  • More than 50 000 people die of the bacterial pneumonia every year in the USA;
  • A hospital-acquired pneumonia is often a cause of the death than the heart attack;
  • The pathogenic organisms causing pneumonia quickly develop a resistance to antibiotics.

The bacterial pneumonia appears as a result of the activation of the morbific organisms:

  • Streptococcus pneumoniae causes the inflammation in 30-50% of all cases;
  • Haemophilus influenzae;
  • Chlamidophila pneumoniae;
  • Legionella pneumophila;
  • Klebsiella pneumoniae.

The disease is airborne during a close contact with an infection carrier. Moreover, a patient does not even notice the signs of the bacterial pneumonia at first.

How do you know if you have pneumonia? Signs of pneumonia

The bacterial pneumonia is a very tricky disease. It appears as a complication of the ARVI or ARD in half of the cases. The symptoms of the pneumonia looks like a common flu. A patient notices weird symptoms only during the complications and goes to a doctor. At this moment, the inflammation affects a significant part of the pulmonary tissues. Due to this, the treatment becomes difficult.

A trigger of the pneumonia is often the body overcooling.

Signs of pneumonia

The symptoms of the pulmonary inflammation include the following manifestations that appear gradually:

  • A sudden hyperthermia of the body, increase of the body temperature, and fever;
  • Symptoms of the body intoxication (fatigue, weakness, headaches);
  • Dry cough turning into the productive one with sputum discharges appear in 3-4 days;
  • Painful sensations in the chest on the part of the affected pulmonary tissues (or both sides during the double pneumonia) during cough, and breathing. Rales and whistling are sometimes heard during breathing.
  • Shortness of breath, severe rales, and heavy sputum discharges appear. These are the signs of the severe affection of the lungs and a respiratory distress.

These signals are not always manifested this way. There are atypical types of the bacterial pneumonia that have rapid semiology. A patient may experience fatigue, headache without fever within a long period. But when bacteria affect most part of the lungs, an acute intoxication happens. The body temperature goes up to 40 degrees, faintness, shortness of breath, rales and difficult breathing appear.

There are also types of the community-acquired bacterial pneumonia that has the ill-defined symptoms. The body temperature is not increased for more than 37,5 degrees, and a patient has a severe cough within 4-6 weeks. It is also dangerous because a patient does not know about the inflammatory process in the lungs. But the degenerative processes happen in the pulmonary tissues at this moment. As a result, it may induce the pulmonary insufficiency.

Therefore, it is necessary to see a doctor during the first signs of the pneumonia and have a medical examination. It is better to make sure that you do not have an inflammatory process in the lungs rather than facing the complications.   

List of antibiotics for pneumonia

The antibacterial therapy is the basic in the pneumonia treatment. But the efficiency of the therapy depends on the correct diagnosis and a type of the activator. So, a patient is prescribed a microbiological test. The matter is that many bacteria strains are not sensitive to the modern antibiotics. The treatment may take 3-4 days but it may be in vain. The symptoms will grow, and the antibiotics will not work.

List of antibiotics for pneumonia

In case of the unknown type of the activator, antibiotics with the broad action are prescribed: penicillin and cephalosporin. They show good results during all types of the pneumonia (both one-sided, and double).

When the type of the activator is detected, the antibiotic is prescribed to which bacteria are sensitive. The list of the best antibiotics for the pneumonia in 2019 is as follows: 

  • Macrolides: Azithromycin (Zithromax);
  • Fluoroquinolones: Ciprofloxacin (Cipro), Levofloxacin (Levaquin);
  • Tetracyclines: Doxycycline, Tetracycline.

Fluoroquinolones are more effective than tetracycline but they may be taken by adults and teenagers at the age of over 16. Tetracycline may be taken from the age of 12.

In case of the bacterial pneumonia of children, a drug of the choice is Amoxil or Zithromax. It is indicated that Zithromax is not allowed children. But in case of the pneumonia, a risk of the complications is higher than the possible side effects of Azithromycin. Therefore the drug is used as the safest and the most advanced one. 

Amoxil works well for children with pneumonia. But many bacteria are not sensitive to penicillin. It is possible to increase the action of Amoxil with the help of clavulanic acid.

Aspiration pneumonia treatment

Aspiration pneumonia is a severe type of the inflammation of the pulmonary tissues. It appears as a result of the entry of liquid or solid particles into the lungs or lower airway tracts. This type of pneumonia may be considered as mechanical one. But the inflammatory process is complicated because disease-causing organisms reach the lungs with aspirate (liquid or item). If the organisms are aggressive, it quickly causes the increase of the inflammation of the pulmonary tissues.  

The clinical aspect may vary during the aspiration pneumonia: from the complete absence of any negative symptoms to the development of the breathing difficulty and a death of a patient.

The main pathogenetic chain causing a development of the aspiration pneumonia is:

  • Mechanical obstruction of the airways tracts;
  • Acute chemical pneumonitis;
  • Bacterial inflammation of the pulmonary tissues. 

The modern international guides for the treatment of the aspiration pneumonia recommend to divide the therapy into several stages:

  • Antibacterial therapy.
  • Elimination of the airway tract obstruction.
  • Removing aspirate that has caused the inflammation of the pulmonary tissues. 

The antibacterial therapy is essential during the aspiration pneumonia.

A choice of the antibiotic depends on:

  • Severity of the disease;
  • Area where the tissue inflammation has appeared;
  • Risk factors for the further infection of the pulmonary tissues.

Doctors often use antibiotics against anaerobic organisms. In case of the community-acquired aspiration pneumonia, these organisms take part in 90% of the infection cases. The best solution is a use of the combined drug Augmentin (penicillin + clavulanic acid). One third of anaerobes produce beta-lactamase, and therefore the use of the clear penicillin is pointless. 

The combined therapy – Augmentin with Metronidazole pills – also shows a high efficiency. Metronidazole has a high activity as to all anaerobes, the quantity of the resistant strains is not more than 10%.  

Tetracycline agents and cephalosporin give a high efficacy during the aspiration pneumonia. It has been proved during the clinical studies that adding Metronidazole to the antibacterial therapy increases the efficacy by 30-40%.

Corticosteroids are also prescribed patients along with antibiotics in order to reduce the inflammation and reduce the obstruction of the airway tracts. They restore the lung functions and prevent a development of the complications. Removing the aspirate happens after the endoscopic examination. To keep the vital functions of the body, a patient may need oxygen-therapy.

In case of the severe type of the aspiration pneumonia, an aggressive therapy is conducted in order to remove the aspirate and restore the lung functions:

  • An infusion of the bronchial spasmolytic by means of the inhalations;
  • An ablution/cleaning the airways tracts;
  • Intravenous/endotracheal injection of the mucolytic and antihypoxic drugs.

Doctors should detect a type of the aspirate, area of the pathology and an intensity of the therapy as soon as possible. The main task is to prevent the pulmonary obstruction and a spread of the infection.   

Klebsiella pneumoniae treatment

Klebsiella pneumoniae is opportunistic pathogenic microflora that lives in the gastro-intestinal tract. It is gram-negative flora that lives in the intestine and is not dangerous. But in case of the decrease in the immunity, bacteria may replicate and affect the internal organs. At first, the organs of the gastro-intestinal tract suffer, and then the pathogenic organisms penetrate into the organs of the urinary system.

The inflammation of the pulmonary tissue is possible in two cases:

  • When the aspirate with Klebsiella pneumonia bacteria goes to the airway tracts from the gastro-intestinal tract;
  • During the active replication of the pathogenic organisms. When bacteria reach the blood, they are transferred to the lungs and induce the inflammatory process.

A danger of Klebsiella pneumonia consists in possible mutations. This bacterium has a resistance to most antibiotics. Several cases of the full resistance of Klebsiella pneumonia to all types of the antibiotics have been detected within the past 5 years. Due to this reason, doctors recommend to follow certain rules:

  • Do not take antibiotics without prescription;
  • Follow doctor’s recommendations and do not take medications longer than needed;
  • Start taking an antibiotic after detecting an infection activators.  

The peculiar symptoms appear during the Klebsiella pneumonia:

  • Increase of the body temperature up to 38-39 degrees Celsius;
  • Intoxication;
  • Atony;
  • High sweatiness; 
  • Bad breath;
  • Severe cough with expectoration.  

A peculiarity of the Klebsiella pneumonia is that sputum has a thick structure and a bad smell. It is one of the most important indicators during detecting a type of the activator. The antibacterial therapy is essential during Klebsiella pneumonia. The treatment begins after getting the results of the microbiological blood tests. To detect the infection activator, doctors take sputum of a patient.

The most effective antibiotics for the Klebsiella pneumonia are as follows:

  • Penicillin (Amoxicillin);
  • Fluoroquinolones (Levofloxacin).   

A choice of the antibiotics is small during this diagnosis. Therefore, patients are also prescribed the following therapy besides the antibacterial one:

  • Probiotics to restore the flora in the gastro-intestinal tract;
  • Bacteriophage – drugs destroying the cells of Klebsiella pneumonia. They have a narrow action and are ineffective during other types of the pneumonia.   

A peculiarity of Klebsiella pneumonia is that bacteria do not induce the intensive affection of the pulmonary tissue. Doctors have to examine a patient and prescribe the proper treatment. complications of Klebsiella pneumonia are just the same as in other types of pneumonia. But a risk of the complication is small because of the weak activity of bacteria.

Risks grow if:

  • Incorrect choice of the antibiotic;
  • Terminated treatment;
  • Using just antibacterial products.  

If the microflora has developed a resistance to the taken antibiotic, replace it immediately, otherwise, the disease will quickly progress.

MRSA pneumonia treatment

MRSA pneumonia has severe clinical manifestations and is inclined to induce severe complications. An activator of the MRSA pneumonia is Methicillin-resistant Staphylococcus aureus. It is a specific type of pneumonia. When the pathogenic microflora penetrates into the airway tracts of patients outside the hospital, the inflammation of the pulmonary tissues occurs in just 2% of the cases. But if a patient stays in the hospital, the entry of Staphylococcus aureus in the airway tracts causes a pneumonia in 15-20%.

MRSA pneumonia may relapse after the recovery and has a high percentage of death rate (from 25 to 40% of the cases). Staphylococcus aureus produce numerous toxins that affect the immune cells. Due to this, the disease quickly progresses and is hardly treatable. MRSA pneumonia needs a special approach in terms of the antibacterial therapy. 

Methicillin-resistant Staphylococcus aureus is insensible to all existing beta-lactamase antibiotics: penicillin, cephalosporin, and carbapenems. Their administration is pointless and even dangerous. Using these antibiotics, bacteria produce special enzymes that enhance their mutation. In 10-15% of the cases, bacteria may mutate and then lose the sensitivity to the antibiotics from other groups. 

The scientists from the University of Strasbourg have detected how Staphylococcus aureus resist the action of the antibiotics. Ribosome cell organs helps them and are responsible for the protein synthesis. The scientists have detected a special structure of ribosomes inside the cells of Staphylococcus aureus. The obtained information has been used during the creation of the completely new antibacterial product to treat the MRSA pneumonia. But none drug has been developed yet. 

A specific feature of the MRSA pneumonia is an acute increase of the body temperature (up to 40ºС and more). The temperature lasts for a long period, the antifebrile products do not really help. As a result, cough with purulent sputum and a shortness of breath appear. These are the essential manifestations of the disease.

The results of the microbiological studies are usually obtained within 1-2 days. But the treatment must be started as soon as possible. Therefore, patients are prescribed broad action antibiotics:

  • Vancomycin (a drug of choice);
  • Azithromycin;
  •  Levofloxacin.  

When the pathogenic organisms have been confirmed, a patient may change the scheme of the treatment and a daily dosage.

Besides the antibacterial therapy, patients with the MRSA pneumonia are prescribed:

  • Disinfection medications.
  • Non-steroid anti-inflammatory products.
  • Immunomodulatory drugs + vitamins.

In case of the development of the respiratory distress, a patient is prescribed corticosteroids (intravenously or inhalation).

MRSA pneumonia is treated in the hospital, under doctor’s supervision. The antibacterial therapy takes 7 to 14 days. A patient is prescribed a maintaining therapy after the acute phase of the treatment: physiotherapeutic procedures, breathing exercises, and immunostimulants.  

The MRSA pneumonia has a high risk of the relapse within a month after the recovery. Therefore a patient should not relax after the discharge from the hospital and must follow all doctor’s recommendations.

Fungal pneumonia treatment

Fungal pneumonia is a very dangerous disease because it is symptom-free in 50% of the cases. A peculiarity of the fungal diseases is that the pathogenic fungi show a low activity. They slowly affect the new cells and enhance an area of the inflammatory process.

The fungal pneumonia may occur in two cases:

  • During the entry of the pathogenic fungi into the airway tracts;
  • During the activation of the potentially pathogenic microflora after the use of the antibiotics.

There are cases when the fungal pneumonia appears after the treatment of the bacterial pneumonia. Antibiotics kill not only pathogenic organisms, they also affect the cells of the good flora. Due to this, an acute microflora imbalance appears, so that many fungal pathogenic agents start replicating. Fungi are not affected under the action of the common antibiotics, and therefore they are left in great number after the antibacterial therapy.

Three types of fungi often cause the pneumonia:

  • Histoplasma capsulatum causes histoplasmosis;
  • Coccidioides immitis causes coccidomycosis;
  • Candida albicans causes candidiasis;
  • Blastomyces dermatitidis causes blastomycosis.

Some people with the fungal pneumonia have the symptoms similar to the flu symptoms. Sometimes the symptoms of the chronic infection of the lungs last for several months. The inflammation may spread on other organs: skin, joints, meninges, and others.

People with immunodeficiency are at a risk group. The increase of the cases of the fungal pneumonia makes a contribution to the growth of patients with malignant and hematologic diseases, and HIV infection. In case of the normal immune status, a risk of the infection of the fungal infection is by 30% lower. Due to the weak immunity, a faster replication of fungi happens, and a risk of the infection transmission grows. The fungal pneumonia may become chronic. A person becomes a carrier of the fungi and infect other people during a close contact.

The treatment of the fungal pneumonia is complicated because most antibiotics are ineffective.

To treat this pathology, the following medications are used: 

  • Antifungal drugs: Fluconazole, Itraconazole, Ketoconazole.
  • Antiprotozoal drugs: Metronidazole (Flagyl);
  • Polyvitamins and immunomodulators for the patients with weak immunity;
  • Glucocorticosteroids to reduce the inflammation;
  • Desintoxication therapy to relieve the disease symptoms.

A base of the pharmaceutical treatment is antifungal medications. If a type of the fungal infection is unknown, Fluconazole is prescribed. The drug has a broad action and is active as to all types of the fungal pneumonia. As soon as the doctor gets the results of the microbiological tests, he/she will prescribe the most appropriate drug.

Metronidazole is ineffective as to fungi. But the fungal pneumonia is often complicated by the anaerobe infections. In order to prevent it and accelerate the process of the recovery, doctors enhance the therapy with Metronidazole.

To remove the vast inflammatory process, take glucocorticosteroids. They are harmless in small doses and help to better restore the functions of the lungs after the pneumonia. A peculiarity of the fungal pneumonia treatment is that the administration of the antifungal drugs is continued within 1-3 months after the recovery. It is done to kill all left particles of fungi and eliminate the infection carrier state. 

Do antibiotics help pneumonia?

As of today the medicine is not able to offer the alternative options of the pneumonia treatment. The only effective way is an antibacterial therapy. Antibiotics helps during most types of the pneumonia regardless of the severity of the disease.

Unfortunately, there are many pathogenic microorganisms that are not sensitive to the antibiotics. But this problem is solved by the implementation of the combined therapy with the use of Metronidazole, immunomodulators, and corticosteroids.

Antibiotics help during the pneumonia when the disease is caused by the bacterial organisms. In case of the viral pneumonia, they work as a support function in order to reduce a risk of the disease relapse.

The use of the antibiotics is contraindicated during the fungal pneumonia:

  • First, they are not active as to fungi.
  • Secondly, they may harm even more killing the good microflora.

The main task of the modern medicine consists in the search of the methods to increase the efficiency of the antibiotics during the pneumonia. Penicillin, cephalosporin agents lose the ability to kill the activator of the pneumonia. It happens because of the bacteria mutation.

About 25% of the cases of the hospital pneumonia are not treatable by the antibiotics. Unfortunately, most of these patients die not waiting for the treatment. Patients are mainly guilty. Most of us do not visit a doctor and self-treat. The uncontrolled use of the antibiotics kills the good microflora in the body. And the opportunistic pathogenic microflora develops a resistance. When the person has pneumonia, the prescribed antibiotics are ineffective. The morbific microorganisms mutate and are not treatable.

Do not take antibiotics, if the doctor did not prescribe it. If you have the self-treatment, it may play a cruel joke with you in the future.     

Strongest antibiotic for pneumonia

A specificity of the antibiotic choice to treat the pneumonia has changed. Azithromycin has been actively used. It effectively arrests the disease symptoms and works for adults and children. But due to this, many bacteria develop a resistance. In spite of this, Azithromycin may be still called as a strong antibiotic for the pneumonia.

It is rather difficult to choose the strongest antibiotic. Every type of the pneumonia has its own pathogenic organisms, and a choice of the drug depends on it. Fluoroquinolones show a good efficacy. The strongest antibiotics from this group are Ciprofloxacin (Cipro) and Levofloxacin (Levaquin). These drugs are not allowed children.

There is another antibiotic that is prescribed for urgent cases. It is Vancomycin. The antibiotic belongs to the “strategic reserve” and is used in extreme cases. Bacteria do not have a resistance yet.

Vancomycin is the strongest antibiotic during the pneumonia. But it is prescribed seldom in order to keep the efficacy as to super bacteria. Therefore you will not be prescribed Vancomycin, if you have pneumonia.

Author: Dr. Eddie Louie , Infectious Diseases & Immunology, Internal Medicine, Phone: (212) 682-9202