Best Pneumonia Treatment in Hyderabad, India | Expert Lungs Care

Pneumonia treatment depends on the causative organism (bacterial, viral, or fungal), the patient's age, comorbidities, severity of the disease, and clinical condition. At first, healthcare professionals use simple scoring systems to help distinguish between patients who may need intensive care and those who can be managed at home with simple treatments.

The Pneumonia Severity Index (PSI) evaluates 20 variables to classify patients into one of five risk categories (I–V) based on their risk of death within 30 days.

The British Thoracic Society introduced another assessment tool similar to the PSI in 2003. It calculates the risk of 30-day mortality but only uses five variables, including confusion, urea, respiratory rate, blood pressure, and age >65 (CURB65). One point is awarded for each if present, making the tool easier to use.



CURB65 and CRB65 help identify high-risk patients. A score of 0 or 1 defines a low risk of mortality and indicates that a patient can be managed in ambulatory care (outpatient setting). A score of 3 or higher suggests hospital admission. When making treatment decisions, healthcare professionals consider the patient's social circumstances and treatment preferences.

Pneumonia Treatment approaches:

• Conservative management 
• Antibiotics
• Supportive Care
• Antiviral Therapy
• Antifungal Therapy
• Chest Physiotherapy
• Minimally invasive approaches
• Surgical management 

Effective treatment of lung infections depends on the rapid and accurate detection of the offending pathogen.

Conservative management of pneumonia​

Antibiotics: The type of antibiotic depends on the likely cause of the infection and the patient's risk factors. Empiric antibiotic therapy will be started as soon as pneumonia is suspected and tailored later based on culture results:

• Community-Acquired Pneumonia (CAP)

• Outpatient Treatment: This typically involves macrolide or tetracycline antibiotics. A respiratory fluoroquinolone or a beta-lactam plus macrolide is used for patients with comorbidities or regions with high resistance.
• Local resistance patterns should guide the treatment of CAP when available. In previously healthy patients who are appropriate for outpatient treatment, the recommended first-line treatment is a macrolide antibiotic that targets the most common causal pathogen, S. pneumoniae.
• Patients with comorbidities such as diabetes, chronic heart, lung, renal, or liver disease, alcoholism, asplenia, impaired immune system, or recent antibiotic use within the last 3 months have an increased risk for drug-resistant S pneumoniae. As such, a respiratory fluoroquinolone or b-lactam plus a macrolide is recommended.
• Klebsiella pneumoniae treatment includes a 14-day course of a third or fourth-generation cephalosporin or a respiratory quinolone.
• Inpatient Treatment: For moderate to severe cases, a combination of beta-lactam and a macrolide, or fluoroquinolone alone, is recommended.

• Hospital-acquired Pneumonia (HAP): Hospital-acquired pneumonia (HAP) is treated with a combination of antibiotics (targeting multi-drug-resistant organisms (e.g., MRSA and Pseudomonas), oxygen, and sometimes a ventilator. Generally, 7 days of treatment with appropriate antibiotics is recommended for uncomplicated ventilator-acquired pneumonia (VAP) and hospital-acquired pneumonia (HAP). If the illness is more severe, HAP is managed in the hospital ward or the intensive care unit (ICU).

• Atypical Pneumonia (Mycoplasma, Chlamydia, Legionella): Atypical pneumonia treatment involves macrolides or tetracycline antibiotics for milder cases. In more severe cases, fluoroquinolones may be used. Antibiotics are usually given for two weeks or more, even if the patient feels better. Stopping antibiotics too soon can make the reoccurrence of pneumonia making it harder to treat

Supportive Care

• Oxygen Therapy: Oxygen therapy is widely used to treat lung diseases. If the patient is hypoxic (oxygen saturation < 90%), supplemental oxygen is administered via nasal cannula or face mask and can be continued for one to two weeks or until the patient can get enough oxygen from the air without effort. Mechanical ventilation may be required in severe pneumonic cases. The effectiveness of oxygen therapy for pneumonia is not well known. One review found that non-invasive ventilation may be more effective than standard oxygen supplementation.
• Hydration: Adequate fluid intake is essential for patients with pneumonia because it can help loosen mucus in the lungs, prevent dehydration, and speed recovery.
• Analgesia: If pleuritic chest pain is present, NSAIDs or acetaminophen are recommended for pain relief.

Antiviral Therapy

• For viral pneumonia (e.g., influenza), antiviral medications are suggested to reduce the duration of illness within 48 hours of symptom onset. They are also used in suspected cases of viral pneumonia due to herpes simplex virus (HSV).
• COVID-19: Supportive care and antivirals for moderate to severe cases.

Antifungal Therapy

• Treatment depends on the type of fungi, often requiring long-term antifungal therapy. Antifungal treatments are mainly recommended in immunocompromised patients or those at risk for fungal pneumonia (e.g., Histoplasma, Coccidioides, or Aspergillus infections).
• Azole and polyene antifungal drugs will be recommended depending on the suspected pathogen.

Chest Physiotherapy: In cases with thick mucus or large amounts of sputum, chest physiotherapy or postural drainage may help clear the lungs.

Minimally invasive approaches

• Drainage: In patients with significant pleural effusion or abscess, drainage is recommended to remove fluid often using tube or catheter.
• Thoracentesis: This minimally invasive procedure removes fluid from the pleural space using a needle.
• Intubation and Ventilation: For severe pneumonia with respiratory failure or shock, endotracheal intubation and mechanical ventilation may be required.

Surgical management of pneumonia 

Although most patients with pneumonia do not require surgery, it may become necessary if complications arise, such as lung abscesses or empyema. Surgical interventions may include:

• Drainage: Severe cases of pneumonia complicated by abscess formation can be treated with drainage via a percutaneous catheter or surgical intervention.
• Lobectomy or Pneumonectomy: In rare cases, surgical resection of the affected lung tissue may be required when pneumonia results in significant lung destruction.
• Thoracotomy: During this procedure, surgeons make an incision to open the chest and view the lungs so that damaged and dead lung tissue can be removed.

Monitoring and Follow-up

A follow-up X-ray may be needed to ensure the resolution of pneumonia, especially if a complication like an abscess or pleural effusion is present. Previous Infectious Diseases Society of America (IDSA) guidelines recommended chest radiography as the standard method for diagnosing CAP. 

Why do I have pneumonia?

Pneumonia can occur due to various causes, including bacterial, viral, or fungal infections. Risk factors include smoking, weakened immune system, age (young children or elderly), chronic illnesses, or exposure to harmful pathogens. The infection leads to lung inflammation, causing fluid and pus buildup in the alveoli, impairing normal breathing.

Is pneumonia viral or bacterial?

Both viral and bacterial infections can cause pneumonia. Bacterial pneumonia (e.g., from Streptococcus pneumoniae) is typically more severe, while viral pneumonia (e.g., from influenza or respiratory syncytial virus) can range from mild to moderate in severity.

How does pneumonia progress?

Pneumonia typically starts with symptoms such as fever, cough, chills, and shortness of breath. If left untreated, symptoms can worsen, leading to severe problems. Inflammation in the lungs can spread, resulting in complications, such as septic shock, respiratory problems, and pleural abscesses, especially in older people or those with pre-existing health issues.

How can pneumonia affect your health?

Pneumonia can cause severe respiratory problems, leading to low oxygen levels, fatigue, and difficulty breathing. In some patients, it can lead to complications, such as lung abscesses, sepsis, or respiratory failure, especially in vulnerable populations, including the elderly and those with chronic illnesses.

When should I get vaccinated to prevent pneumonia?

Vaccination is recommended for people of different ages. For children, vaccines like the PCV13 (Pneumococcal Conjugate Vaccine) should be included in their regular immunisation schedule. Adults aged 65 and older are recommended to receive PPSV23 (Pneumococcal Polysaccharide Vaccine), and individuals with certain chronic conditions may require it earlier. Smoking adults and those with weakened immune systems may also benefit from pneumococcal vaccination.

What is Streptococcus pneumoniae treatment?

Streptococcus pneumoniae infections are treated with antibiotics. Other antibiotics, like cephalosporins or macrolides, are suggested if the strain is resistant. However, severe cases may require intravenous antibiotics and hospitalisation.

What not to do when you have pneumonia?

If symptoms worsen or don't improve, seeking medical attention is needed, and completing the prescribed antibiotic course is essential. Smoking worsens lung function and delays healing. Always follow the healthcare professional's (pulmonologist) treatment plan.

Can pneumonia come back?

Yes, pneumonia can recur if the initial infection isn't completely treated or the immune system is compromised. It can also reappear if the individual is exposed to new bacteria or viruses.

What is severe pneumonia treatment?

Severe pneumonia treatment includes intravenous antibiotics, oxygen therapy, and sometimes mechanical ventilation if the patient has trouble breathing. Hospitalisation is often required for patients with severe symptoms, and supportive care (e.g., fluids, pain relievers) is provided.