Which Antibiotics Treat Pneumonia and What to Expect

If you’ve been diagnosed with bacterial pneumonia, you’ll likely be prescribed antibiotics to treat it. Antibiotics kill bacteria or render them unable to replicate.

Your doctor may prescribe one of many antibiotics for pneumonia. Review what pneumonia is, what treatment for pneumonia may entail, and why your doctor may pick one pneumonia medication over the other.

Pneumonia is a lower respiratory infection. These are infections of the lungs or lung structures, like the bronchi. Pneumonia may make it harder to breathe because the air sacs in the lungs that exchange oxygen with carbon dioxide fill up with fluid.

Viruses or bacteria can cause different types of pneumonia. Less commonly, a fungus can be the culprit.

Viral pneumonia, caused by the viruses that also cause the common cold or flu, typically goes away on its own with enough time and rest. This type of pneumonia tends to be more seasonal in the fall and winter when cold and flu viruses spread.

Recovering from viral pneumonia could take up to three weeks. You can treat pneumonia's fever and pains with over-the-counter medicines. Antibiotics won't help you get better quicker if a virus causes your pneumonia.

Bacterial pneumonia is more common and needs to be treated with antibiotics to resolve fully, which may take a month or more. Bacterial pneumonia may be caused by the same pathogen that caused the original illness. Or it can be a secondary bacterial infection after a viral illness.

Types of Antibiotics for Pneumonia

There are multiple types of antibiotics that work in slightly different ways. Some are more commonly used to treat pneumonia than others based on things like:

• The bacteria causing infection
• The severity of the infection
• If you’re in a patient group at greatest risk from pneumonia

The types of antibiotics that your doctor might typically prescribe for pneumonia include the following:

• Healthy adults under 65 years with pneumonia are typically treated with a combination of amoxicillin plus a macrolide like Zithromax (azithromycin) or sometimes a tetracycline like Vibramycin (doxycycline).
• Adults with other illnesses or who are smokers will usually be prescribed Augmentin (amoxicillin/clavulanic acid), a combination drug that contains both amoxicillin and another antibiotic, the beta-lactam clavulanic acid. Augmentin may be supplemented in these patients with either a macrolide or tetracycline. These other conditions make it difficult for the body to fight off infections and include chronic heart, lung, liver, or kidney diseases, like chronic obstructive pulmonary disease (COPD), diabetes, alcohol use disorder, cancer, and patients without a spleen.
• Adults who can't take penicillin may be prescribed cephalosporin like Rocephin (ceftriaxone) plus either a macrolide or doxycycline.
• Adults who can't take Augmentin because of the beta-lactam will likely be prescribed an inhaled fluoroquinolone like Levaquin (levofloxacin).
• Hospitalized adults who are not likely to have methicillin-resistant Staphylococcus aureus (MRSA) or Pseudomonas are treated with either combination therapy of a beta-lactam plus macrolide or with a fluoroquinolone.
• Hospitalized adults with Pseudomonas will be treated with a combination of an antipseudomonal beta-lactam plus an antipseudomonal fluoroquinolone.
• Hospitalized adults with MRSA will also be prescribed an anti-MRSA drug like Vancocin (vancomycin) or Zyvox (linezolid).

Antibiotics prescribed for children with pneumonia include the following:

• Infants, preschoolers, and school-aged children with suspected bacterial pneumonia may be treated with amoxicillin.
• Children with suspected atypical pneumonia can be treated with macrolides.
• Children allergic to penicillin will be treated with other antibiotics as needed for the specific pathogen.
• Hospitalized, immunized children can be treated with ampicillin or penicillin G.
• Hospitalized children and infants who are not fully vaccinated may be treated with a cephalosporin.
• Hospitalized children with suspected M. pneumoniae or C. pneumoniae infection may be treated with combination therapy of a macrolide (such as azithromycin or clarithromycin) and a beta-lactam antibiotic (such as ampicillin or amoxicillin).
• Hospitalized children with suspected S. aureus infections might be treated with a combination of Vancocin or clindamycin and a beta-lactam.

How Your Doctor Chooses

Your doctor will select the right antibiotic for you based on multiple factors, including:

• Your age: People 65 and older have a greater risk of serious complications from pneumonia infections.
• Your health history: A history of smoking, lung diseases, or other conditions may influence a person's ability to fight off infections.
• The exact infection you have: Your doctor may take a sample and test it for bacteria. They can then pick an antibiotic based on your specific infection.
• Your previous experiences with antibiotics: Make sure to tell your doctor if you are allergic to any medications, had bad reactions to antibiotics in the past, or have developed an antibacterial-resistant infection.
• The antibiotic sensitivity of the bacteria: The lab will test the bacteria causing your pneumonia to determine which antibiotics it is sensitive or resistant to.

Doctors typically choose your antibiotics prescription based on what medicines they think will be most effective and cause the fewest side effects.

How Long You’ll Take Them

A course of antibiotics for uncomplicated pneumonia treatment is usually for five to seven days. One course will usually be enough to cure your pneumonia. In some cases, you may need more than one course of antibiotics if your infection doesn’t start improving or it seems like it’s not responding to the medications.

Stay in touch with your doctor to ensure your infection is clearing up. You’ll likely start to feel better and have some symptom relief one to three days after you start your pneumonia treatment, but it may take a week or more for your symptoms to go away completely.

Side Effects

Antibiotics are serious drugs and can have some uncomfortable side effects. These can include:

• Gastrointestinal discomfort: Nausea, vomiting, diarrhea, upset stomach, loss of appetite, clay-colored stools, and stomach pain
• Skin issues: Hives, yeast infections (including oral thrush), allergic reactions (skin rash), angioedema (skin swelling), and sensitivity to sunlight

Antibiotics work by killing bacteria, but our bodies are full of bacteria. There are more bacterial cells in our bodies than human cells. The vast majority of these bacteria, called our microbiome, are good for us; they help us digest food and support the immune system.

But antibiotics act indiscriminately, killing any bacteria they can find, even good ones. This indiscriminate killing causes some complications, as harmful bacteria may take over parts of our bodies vacated by the bacteria the antibiotic killed.

Some research suggests that taking a probiotic or eating probiotic foods while you’re taking antibiotics can help avoid some of the immediate and long-term effects of antibiotics on your microbiome.

Summary

Antibiotics are used to treat bacterial pneumonia. Which antibiotic is prescribed is based on the type of bacteria, your age, health history, and more. You will often take the antibiotics for five to seven days. Completing the full course is important. Side effects may occur, which you should report to your doctor.