17th February 2025

Managing bacterial pneumonia

Management of pneumonia includes oxygen therapy and IV crystalloid fluids if the patient is septic. Chest physiotherapy may be used to increase expectoration and alveolar recruitment. 

Non-invasive ventilation (NIV) is not typically indicated in pneumonia but may be undertaken with expert supervision on a case-specific basis. Worsening oxygenation despite appropriate therapy will necessitate intubation and ventilation. The positive end-expiratory pressure (PEEP) from mechanical ventilation can increase oxygenation by increasing alveolar recruitment.  

Antibiotics will be required to treat pneumonia, with IV administration recommended for a CURB-65 score ≥2. Aspiration pneumonia requires an antibiotic with Pseudomonas cover. Atypical pneumonias should be covered with a fluoroquinolone or macrolide antibiotic. In cases of recurrent lower respiratory tract infections due to COPD, a prophylactic antibiotic such as azithromycin may be indicated.