Introduction
Pneumonia is almost always caused by a bacterial infection. The pathogens are transmitted by coughing or sneezing and cause an inflammation of the lower respiratory tract. The most common triggers include pneumococcus in adults, and bacteria of the genus Haemophilus influenzae type b and Staphylococcus aureus in small children.
Bacterial pneumonia is usually treated with antibiotics. In most cases, drug therapy leads to a rapid improvement of the symptoms and healing of the disease. It is important to understand that antibiotics only help with inflammation caused by bacteria. Antibiotics are ineffective for pneumonia that has other causes (e.g. viruses, parasites or fungi).
These antibiotics are used
In the case of pneumonia, antibiotics from the group of beta-lactams are used, for example aminopenicillins. These are preparations that prevent the synthesis of the cell wall and thus the proliferation of pneumonia pathogens. The best known representative of this group is penicillin.
Many people suffer from an allergy to penicillin, which is why fluoroquinolones (e.g. moxifloxacin or levofloxacin) or macrolides (e.g. erythromycin) can be prescribed alternatively. For mild pneumonia, the drugs are taken in tablet form for at least five to seven days.
For severe pneumonia it is advisable to administer a beta-lactamase inhibitor (e.g. ampicillin/sulbactam) in addition to the aminopenicillins. This is administered intravenously via an infusion. In patients with advanced pneumonia, which already causes complications such as septic shock, piperacillin/tazobactam (Pip/Taz) in combination with a macrolide is the drug of choice. This drug is also administered exclusively in hospital and intravenously.
How is it decided which antibiotics are used?
At the beginning of the treatment of pneumonia, the doctor must choose a suitable antibiotic, because not every preparation helps with every bacterium. The doctor starts from a certain bacterial spectrum that normally leads to pneumonia and chooses the medication accordingly. The patient’s medical history also makes it possible to draw possible conclusions about the type of infection (e.g. travel to countries with a high rate of multi-resistant germs, previous mechanical ventilation, residents of nursing homes).
The choice of a suitable antibiotic also depends on whether the patient has allergies or intolerances to certain drugs. Previous antibiotic treatments, their tolerability and possible resistance also influence the choice of antibiotic. In the case of uncomplicated pneumonia, the doctor prescribes a broadly effective antibiotic that is effective against the usual pathogens that cause pneumonia.
In many cases, antibiotic therapy must already be started without knowing the exact pathogen, as this is intended to prevent rapid progression of the disease. In severe cases, which require in-patient treatment, the pathogen is detected and identified in the laboratory (sputum diagnostics, blood cultures). This allows the choice of an antibiotic that is specifically effective against this pathogen. .
All articles in this series:
