Pneumonia is a
lung infection that can make you very sick. You may cough, run a fever, and
have a hard time breathing. For most people, pneumonia can be treated at home.
It often clears up in 2 to 3 weeks. But older adults, babies, and people with
other diseases can become very ill. They may need to be in the hospital.
You can get pneumonia in your daily life, such as at school or work. This
is called community-associated pneumonia. You can also get it when you are in a
hospital or nursing home. This is called healthcare-associated pneumonia. It
may be more severe because you already are ill. This topic focuses on pneumonia
you get in your daily life.
Germs called bacteria or
viruses usually cause pneumonia.
Pneumonia usually starts when you
breathe the germs into your lungs. You may be more likely to get the disease
after having a cold or the
flu. These illnesses make it hard for your lungs to
fight infection, so it is easier to get pneumonia. Having a long-term, or
chronic, disease like
asthma, heart disease, cancer, or
diabetes also makes you more likely to get pneumonia.
Symptoms of pneumonia
caused by bacteria usually come on quickly. They may include:
When you have mild symptoms, your doctor may call this
Older adults may have different, fewer, or
milder symptoms. They may not have a fever. Or they may have a cough but not
bring up mucus. The main sign of pneumonia in older adults may be a change in
how well they think. Confusion or
delirium is common. Or, if they already have a lung
disease, that disease may get worse.
Symptoms caused by viruses
are the same as those caused by bacteria. But they may come on slowly and often
are not as obvious or as bad.
Your doctor will ask
you about your symptoms and do a physical exam. He or she may order a chest
X-ray and a
blood test. This is usually enough for your doctor to
know if you have pneumonia. You may need more tests if you have bad symptoms,
are an older adult, or have other health problems. In general, the sicker you
are, the more tests you will have.
Your doctor may also test mucus
from your lungs to find out if bacteria are causing your pneumonia. Finding out
what is causing your pneumonia can help your doctor choose the best treatment
If pneumonia is caused by
bacteria, your doctor will give you antibiotics. These almost always cure
pneumonia caused by bacteria. Be sure to take the antibiotics exactly as instructed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.
Pneumonia can make you feel very sick. But
after you take antibiotics, you should start to feel much better. Call your
doctor if you do not start to feel better after 2 to 3 days of antibiotics.
Call your doctor right away if you feel worse.
There are things
you can do to feel better during your treatment. Get plenty of rest and sleep,
and drink lots of liquids. Do not smoke. If your cough keeps you awake at
night, talk to your doctor about using cough medicine.
need to go to the hospital if you have bad symptoms, a weak
immune system, or another serious illness.
Pneumonia caused by a virus usually is not treated with antibiotics.
Sometimes, antibiotics may be used to prevent complications. But home
treatment, such as rest and taking care of your cough, usually is all that is
Experts recommend immunization for children and adults. Children get the pneumococcal vaccine as part of their routine shots. If you are 65 or older, you smoke, or you have a long-term health problem, it's a good idea to get a
pneumococcal vaccine. It may not keep you from getting pneumonia. But if you do
get pneumonia, you probably won't be as sick.
You can also
lower your chances of getting pneumonia by staying away from people who have
the flu, colds, measles, or chickenpox. You may get pneumonia after you have
one of these illnesses.
Wash your hands often. This helps prevent the spread of viruses and bacteria
that may cause pneumonia.
Learning about pneumonia:
Living with pneumonia:
Health Tools help you make wise health decisions or take action to improve your health.
Viruses, bacteria, or (in rare
cases) parasites or other organisms can cause
In people with
impaired immune systems, pneumonia may be caused by
other organisms, including some forms of fungi, such as Pneumocystis jiroveci (formally called Pneumocystis carinii). This fungus frequently causes
pneumonia in people who have AIDS. Some doctors may
HIV test if they think that Pneumocystis jiroveci is causing the pneumonia.
You may get pneumonia:
A healthy person's nose and throat often contain bacteria
or viruses that cause pneumonia. Pneumonia can develop when these organisms
spread to your lungs while your lungs are more likely to be infected. Examples of times when this can happen are during or soon after a cold or if you have a long-term (chronic) illness, such
chronic obstructive pulmonary disease (COPD).
You can get pneumonia in your daily life, such as at school or work
(community-associated pneumonia) or when you are in a hospital or nursing home
(healthcare-associated pneumonia). Treatment may differ
in healthcare-associated pneumonia, because bacteria causing the infection in
hospitals may be different from those causing it in the community. This topic
focuses on community-associated pneumonia.
pneumonia caused by bacteria in otherwise healthy
people younger than 65 usually come on suddenly. They often start during or
upper respiratory infection, such as the
flu or a cold. Symptoms may include:
Symptoms of pneumonia not caused by bacteria may come on gradually and are often not as bad or as obvious as symptoms of bacterial pneumonia. Many people don't know that they have
nonbacterial pneumonia, because they don't feel sick. But symptoms may include:
symptoms are mild, your doctor may call your condition "walking
Older adults may have
different, fewer, or milder symptoms, such as having no fever or having a cough with no mucus
(a dry or nonproductive cough). The major sign of pneumonia in older adults may
be a change in how clearly they think (confusion or
delirium) or when a lung disease they already have
In children, symptoms may depend on age:
Some conditions with symptoms similar to pneumonia include bronchitis,
After you've been infected
with a pneumonia-causing organism, it takes as little as 1 to 3 days or as long
as 7 to 10 days for symptoms to appear. How severe
pneumonia is and how long it lasts depend on:
In healthy people, pneumonia can be a mild illness that is
hardly noticed and clears up in 2 to 3 weeks. In older adults and in people
with other health problems, recovery may take 6 to 8 weeks or longer.
have severe pneumonia, you may have to go to the hospital:
If your pneumonia is caused by a virus or bacteria, you may
spread the infection to other people while you are contagious. How long you are
contagious depends on what is causing the pneumonia and whether you get
treatment. You may be contagious for several days to a week.
If you get
antibiotics, you usually cannot spread the infection to others after a day of
You are more likely to get
pneumonia if you:
You are more likely to have
complications of pneumonia and may need to go to the
hospital if you:
The faster you get treatment,
the faster you will get over
pneumonia. This is especially true for the very young,
for people older than 65, and for anyone with other long-lasting (chronic)
health problems, such as
Call 911 or other emergency services immediately if you:
Call a doctor immediately if you
Call a doctor if your cough:
Also call your doctor if you have new chest pain (more than
just discomfort when you cough) that gets worse with deep breathing and if you
have other symptoms of pneumonia, such as shortness of breath, cough, and
Watchful waiting is a wait-and-see approach. If
you get better on your own, you won't need treatment. If you get worse, you and
your doctor will decide what to do next.
Home treatment may be
Health professionals who can diagnose and treat
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Your doctor will usually diagnose
The need for more tests often depends on how severe
your symptoms are, your age, and your overall health. In general, the sicker
you are, the more tests you will have. This is especially true for older adults
If you are very ill, have severe shortness of breath, or
have a condition that increases your risk (such as
COPD), your doctor
may test your mucus. Tests include a Gram stain and a sputum culture.
This test can identify some bacteria that cause pneumonia. This can help guide treatment for pneumonia.
In people who have
impaired immune systems, pneumonia may be caused by
other organisms, including some forms of fungi, such as Pneumocystis jiroveci (formally called Pneumocystis carinii). This fungus often causes
pneumonia in people who have AIDS. Some doctors may
HIV test if they think that Pneumocystis jiroveci is causing the pneumonia.
If you have severe pneumonia, you may need
other tests, including tests to check for
complications and to find out how well your
immune system is working.
antibiotics to treat
pneumonia caused by bacteria, the most common cause of
the condition. Antibiotics have a high cure rate for pneumonia.5
Your doctor will
choose your antibiotic based on a number of things,
including your age, your symptoms and how severe they are, and whether you need
to go to the hospital. The number of days you take antibiotics depends on your general
health, how serious your pneumonia is, and the type of antibiotic you are
Most people see some
improvement in symptoms in 2 to 3 days. Unless you get worse during this time,
your doctor usually will not change your treatment for at least 3 days.
Getting started on antibiotics soon after getting pneumonia may help recovery.5
there is no improvement or if your symptoms get worse, you may need a
culture and a sensitivity test. These tests help
identify the organism that is causing your symptoms. These tests also help your
doctor find out whether the bacteria is
resistant to the antibiotic.
If you do not need to go to the
hospital for pneumonia, it is not usually necessary to identify the organism
causing the pneumonia before starting treatment. If you do go to the hospital,
you will probably have some testing to identify the bacteria.
will not have to go to the hospital unless you:
Pneumonia also can be caused by
viruses, such as those that cause the
chickenpox (varicella). Antibiotics do not work to treat pneumonia caused by a virus.
In most cases pneumonia is a short-term,
treatable illness. But frequent bouts of pneumonia can be a serious
complication of a long-term (chronic) illness, such as chronic obstructive
pulmonary disease (COPD). If you have a severe long-term illness, it may be
hard to treat your pneumonia, or you may choose not to treat it. You and
your doctor should discuss this. This discussion may include information about how to create an
For more information, see:
There are a number of steps you can take to
help prevent getting
Children get pneumococcal conjugate vaccine (PCV)(What is a PDF document?) as a routine vaccination. Older adults (age 65 or older), people who smoke, and people who have
some long-term (chronic) conditions also need the pneumococcal vaccine. Depending on age and other things, adults can get PCV or the
pneumococcal polysaccharide vaccine (PPSV)(What is a PDF document?). Some adults need both types.
The pneumococcal vaccine may not prevent pneumonia. But it can prevent some of the serious complications of pneumonia, such as
infection in the bloodstream (bacteremia) or throughout the body (septicemia),
in younger adults and those older than age 55 who have a healthy immune
Other vaccines can prevent common diseases that sometimes lead to pneumonia, such as:
Home treatment is important for
pneumonia. The following measures can help you recover
Your doctor may want to see you after a week of treatment to make sure
you are getting better. Be sure to contact your doctor if you do not feel
better, your cough gets worse, you have shortness of breath or a fever, you
feel weak, or you feel faint when you stand up.
Be careful with cough and cold medicines. They may not be safe for young children or for people who have certain health problems, so check the label first. If you do use these medicines, always follow the directions about how much to use based on age and weight.
Always check to see if any over-the-counter cough or cold
medicines you are taking contain acetaminophen. If they do, make sure the
acetaminophen you are taking in your cold medicine plus any other
acetaminophen you may be taking is not higher than the daily recommended dose.
Ask your doctor or pharmacist how much you can take every day.
Doctors use antibiotics to treat pneumonia that is caused by bacteria. Although experts differ on their recommendations, the
first antibiotic used is usually one that kills a wide range of bacteria
(broad-spectrum antibiotic).8, 9 All antibiotics used have a high cure rate for
There are many types of antibiotics. Your doctor will decide which antibiotic will work best for you. In most cases, a doctor will
prescribe antibiotics without first identifying the exact organism causing the
If you don't get better with your first antibiotic, your doctor may add a second antibiotic to cover
other bacteria that are not being treated with the first
one. Or you may have more testing to identify the specific organism that is
causing the pneumonia.
Sometimes doctors use two antibiotics when first starting treatment.
More and more bacteria are becoming resistant to certain antibiotics, making them less
effective. An example of this is MRSA, or methicillin-resistant Staphylococcus aureus, which is resistant to many types of
penicillin. To help fight antibiotic resistance, ask your doctor
how to take your antibiotics correctly, such as always finishing your
In most cases of
pneumonia in young, otherwise healthy people with
immune systems, treatment can be done at home.
Antibiotics, rest, fluids, and home care are all that you need in order to
recover. But people who are having trouble breathing or have other lung
problems may need more treatment. Sometimes you may need
oxygen or medicines you breathe using an
nebulizer to help shortness of breath and wheezing
If home treatment does not help,
if symptoms get worse, or if signs of
complications of pneumonia develop, you may have to go
to the hospital. Hospital treatment for pneumonia may include:
The American Lung Association provides programs of
education, community service, and advocacy. Some of the topics available
include asthma, tobacco control, emphysema, infectious disease, asbestos, carbon monoxide, radon,
The Centers for Disease Control and Prevention (CDC) is
an agency of the U.S. Department of Health and Human Services. The CDC works
with state and local health officials and the public to achieve better health
for all people. The CDC creates the expertise, information, and tools that
people and communities need to protect their health—by promoting health,
preventing disease, injury, and disability, and being prepared for new health
The U.S. National Heart, Lung, and Blood Institute
(NHLBI) information center offers information and publications about preventing
The National Institute of Allergy and Infectious
Diseases conducts research and provides consumer information on infectious and
CitationsNiederman MS (2004). Pneumonia, including community-acquired and nosocomial pneumonia. In JD Crapo et al., eds., Baum's Textbook of Pulmonary Diseases, 7th ed., vol. 1, pp. 424–454. Philadelphia: Lippincott Williams and Wilkins.File TM Jr (2003). Community-acquired pneumonia. Lancet, 362(9400): 1991–2001.Laheij RJF, et al. (2004). Risk of community-acquired pneumonia and use of gastric acid-suppressive drugs. JAMA, 292(16): 1955–1960.Herzig SJ, et al. (2009). Acid-suppressive medication use and the risk for hospital-acquired pneumonia. JAMA, 301(20): 2120–2128.Loeb M (2010). Community-acquired pneumonia, search date January 2010. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.Moberley SA, et al. (2008). Vaccines for preventing pneumococcal infection in adults. Cochrane Database of Systematic Reviews(1). Oxford: Update Software.Maruyama T, et al. (2010). Efficacy of 23-valent pneumococcal vaccine in preventing pneumonia and improving survival in nursing home residents: Double blind, randomised and placebo controlled trial. BMJ. Published online March 8, 2010 (doi: 10.1136/bmj.c1004).Arnold FW, et al. (2009). Improving outcomes in elderly patients with community-acquired pneumonia by adhering to national guidelines: Community-Acquired Pneumonia Organization International cohort study results. Archives of Internal Medicine, 169(16): 1515–1524.McCabe C, et al. (2009). Guideline-concordant therapy and reduced mortality and length of stay in adults with community-acquired pneumonia: Playing by the rules. Archives of Internal Medicine, 169(16): 1525–1531.Other Works ConsultedCenters for Disease Control and Prevention (2010). Updated recommendations for prevention of invasive pneumococcal disease among adults using the 23-valent pneumococcal polysaccharide vaccine (PPSV23). MMWR, 59(34): 1102–1106. Also available online:Centers for Disease Control and Prevention (2010). Prevention of pneumococcal disease among infants and children: Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine - Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR, 59(RR-11): 1–18. Also available online:Fiebach NH, Barr RG (2007). Respiratory tract infections. In NH Fiebach et al., eds., Principles of Ambulatory Medicine. 7th ed., pp. 474–500. Philadelphia: Lippincott Williams and Wilkins.Mandell LA, et al. (2007). Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clinical Infectious Diseases, 44(Suppl 2): S27-S72.Murray MT (2013). Bronchitis and pneumonia. In JE Pizzorno Jr, MT Murray, eds., Textbook of Natural Medicine, 4th ed., pp. 1271–1276. St. Louis: Elsevier.Musher DM (2010). Streptococcus pneumoniae. In GL Mandell et al., eds., Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 7th ed., vol. 2, pp. 2623–2642. Philadelphia: Churchill Livingstone Elsevier.Torres A, et al. (2010). Pyogenic bacterial pneumonia and lung abscess. In R Mason et al., eds., Murray and Nadel's Textbook of Respiratory Medicine, 5th ed., vol. 1, pp. 699–740. Philadelphia: Saunders.
March 17, 2011
E. Gregory Thompson, MD - Internal Medicine & R. Steven Tharratt, MD, MPVM, FACP, FCCP - Pulmonology, Critical Care Medicine, Medical Toxicology
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