Editing Pneumonia (section)

===Bacterial===
Antibiotics improve outcomes in those with bacterial pneumonia.<ref name=CochraneTx13/> The first dose of antibiotics should be given as soon as possible.<ref name="Elena 2015"/> Increased use of antibiotics, however, may lead to the development of [[Antimicrobial resistance|antimicrobial resistant]] strains of bacteria.<ref name=Pak2014>{{cite journal | vauthors = Pakhale S, Mulpuru S, Verheij TJ, Kochen MM, Rohde GG, Bjerre LM | title = Antibiotics for community-acquired pneumonia in adult outpatients | journal = The Cochrane Database of Systematic Reviews | issue = 10 | pages = CD002109 | date = October 2014 | volume = 2014 | pmid = 25300166 | pmc = 7078574 | doi = 10.1002/14651858.CD002109.pub4 }}</ref> Antibiotic choice depends initially on the characteristics of the person affected, such as age, underlying health, and the location the infection was acquired. Antibiotic use is also associated with side effects such as nausea, diarrhea, dizziness, taste distortion, or headaches.<ref name=Pak2014/> In the UK, [[Empiric therapy|treatment before culture results]] with [[amoxicillin]] is recommended as the first line for community-acquired pneumonia, with [[doxycycline]] or [[clarithromycin]] as alternatives.<ref name=BTS09/> In North America, amoxicillin, doxycycline, and in some areas a macrolide (such as [[azithromycin]] or [[erythromycin]]) is the first-line outpatient treatment in adults.<ref name=EOP10/><ref name=Lutfiyya>{{cite journal | vauthors = Lutfiyya MN, Henley E, Chang LF, Reyburn SW | title = Diagnosis and treatment of community-acquired pneumonia | journal = American Family Physician | volume = 73 | issue = 3 | pages = 442–50 | date = February 2006 | pmid = 16477891 | url = http://www.aafp.org/afp/2006/0201/p442.pdf | url-status = live | archive-url = https://web.archive.org/web/20120409042309/http://www.aafp.org/afp/2006/0201/p442.pdf | archive-date = 9 April 2012 }}</ref><ref name=Met2019/> In children with mild or moderate symptoms, amoxicillin taken by mouth is the first line.<ref name=PIDS11/><ref>{{cite web|url=https://www.who.int/mediacentre/factsheets/fs331/en/|title=Pneumonia Fact Sheet|date=September 2016|website=World Health Organization|language=en-GB|access-date=14 January 2018}}</ref><ref>{{cite journal | vauthors = Lodha R, Kabra SK, Pandey RM | title = Antibiotics for community-acquired pneumonia in children | journal = The Cochrane Database of Systematic Reviews | issue = 6 | pages = CD004874 | date = June 2013 | volume = 2013 | pmid = 23733365 | pmc = 7017636 | doi = 10.1002/14651858.CD004874.pub4 }}</ref> The use of [[fluoroquinolones]] in uncomplicated cases is discouraged due to concerns about side-effects and generating resistance in light of there being no greater benefit.<ref name=EOP10/><ref>{{cite journal | vauthors = Eliakim-Raz N, Robenshtok E, Shefet D, Gafter-Gvili A, Vidal L, Paul M, Leibovici L | title = Empiric antibiotic coverage of atypical pathogens for community-acquired pneumonia in hospitalized adults | journal = The Cochrane Database of Systematic Reviews | volume = 9 | issue = 9 | pages = CD004418 | date = September 2012 | pmid = 22972070 | pmc = 7017099 | doi = 10.1002/14651858.CD004418.pub4 | editor1-last = Eliakim-Raz | editor1-first = Noa }}</ref>

For those who require hospitalization and caught their pneumonia in the community the use of a β-lactam such as [[cephazolin]] plus a macrolide such as azithromycin is recommended.<ref>{{cite journal |vauthors=Lee JS, Giesler DL, Gellad WF, Fine MJ |date=February 2016 |title=Antibiotic Therapy for Adults Hospitalized With Community-Acquired Pneumonia: A Systematic Review |url=https://jamanetwork.com/journals/jama/article-abstract/2488313 |journal=JAMA |volume=315 |issue=6 |pages=593–602 |doi=10.1001/jama.2016.0115 |pmid=26864413}}</ref><ref name=Met2019/> A [[fluoroquinolone]] may replace azithromycin but is less preferred.<ref name=Met2019/> Antibiotics by mouth and by injection appear to be similarly effective in children with severe pneumonia.<ref name=Roj2006>{{cite journal | vauthors = Rojas MX, Granados C | title = Oral antibiotics versus parenteral antibiotics for severe pneumonia in children | journal = The Cochrane Database of Systematic Reviews | issue = 2 | pages = CD004979 | date = April 2006 | volume = 2006 | pmid = 16625618 | pmc = 6885030 | doi = 10.1002/14651858.CD004979.pub2 }}</ref>

The duration of treatment has traditionally been seven to ten days, but increasing evidence suggests that shorter courses (3–5 days) may be effective for certain types of pneumonia and may reduce the risk of antibiotic resistance.<ref>{{cite journal | vauthors = Tansarli GS, Mylonakis E | title = Systematic Review and Meta-analysis of the Efficacy of Short-Course Antibiotic Treatments for Community-Acquired Pneumonia in Adults | journal = Antimicrobial Agents and Chemotherapy | volume = 62 | issue = 9 | date = September 2018 | pmid = 29987137 | pmc = 6125522 | doi = 10.1128/AAC.00635-18 }}</ref><ref>{{cite journal | vauthors = Scalera NM, File TM | title = How long should we treat community-acquired pneumonia? | journal = Current Opinion in Infectious Diseases | volume = 20 | issue = 2 | pages = 177–81 | date = April 2007 | pmid = 17496577 | doi = 10.1097/QCO.0b013e3280555072 | s2cid = 21502165 }}</ref><ref name=Pug2015>{{cite journal | vauthors = Pugh R, Grant C, Cooke RP, Dempsey G | title = Short-course versus prolonged-course antibiotic therapy for hospital-acquired pneumonia in critically ill adults | journal = The Cochrane Database of Systematic Reviews | issue = 8 | pages = CD007577 | date = August 2015 | volume = 2015 | pmid = 26301604 | pmc = 7025798 | doi = 10.1002/14651858.CD007577.pub3 }}</ref><ref>{{cite journal | vauthors = Haider BA, Saeed MA, Bhutta ZA | title = Short-course versus long-course antibiotic therapy for non-severe community-acquired pneumonia in children aged 2 months to 59 months | journal = The Cochrane Database of Systematic Reviews | issue = 2 | pages = CD005976 | date = April 2008 | pmid = 18425930 | doi = 10.1002/14651858.CD005976.pub2 | url = https://ecommons.aku.edu/cgi/viewcontent.cgi?article=1134&context=pakistan_fhs_mc_women_childhealth_paediatr }}</ref> Research in children showed that a shorter, 3-day course of amoxicillin was as effective as a longer, 7-day course for treating pneumonia in this population.<ref>{{cite journal |date=27 May 2022 |title=3 days' antibiotic is effective in childhood pneumonia |url=https://evidence.nihr.ac.uk/alert/short-course-antibiotics-effective-in-childhood-pneumonia/ |access-date=8 June 2022 |website=NIHR Evidence |doi=10.3310/nihrevidence_50885 |s2cid=249937345 |language=en-GB}}</ref><ref>{{cite journal |last1=Barratt |first1=Sam |last2=Bielicki |first2=Julia A. |last3=Dunn |first3=David |last4=Faust |first4=Saul N. |last5=Finn |first5=Adam |last6=Harper |first6=Lynda |last7=Jackson |first7=Pauline |last8=Lyttle |first8=Mark D. |last9=Powell |first9=Colin VE |last10=Rogers |first10=Louise |last11=Roland |first11=Damian |date=4 November 2021 |title=Amoxicillin duration and dose for community-acquired pneumonia in children: the CAP-IT factorial non-inferiority RCT |journal=Health Technology Assessment |language=EN |volume=25 |issue=60 |pages=1–72 |doi=10.3310/hta25600 |pmid=34738518 |s2cid=243762087 |issn=2046-4924 |doi-access=free }}</ref> For pneumonia that is associated with a ventilator caused by non-fermenting Gram-negative bacilli (NF-GNB), a shorter course of antibiotics increases the risk that the pneumonia will return.<ref name=Pug2015/> Recommendations for hospital-acquired pneumonia include third- and fourth-generation [[cephalosporins]], [[carbapenem]]s, fluoroquinolones, [[aminoglycoside]]s, and [[vancomycin]].<ref name=ATS2005/> These antibiotics are often given [[intravenous therapy|intravenously]] and used in combination.<ref name=ATS2005/> In those treated in hospital, more than 90% improve with the initial antibiotics.<ref name=M32/> For people with ventilator-acquired pneumonia, the choice of antibiotic therapy will depend on the person's risk of being infected with a strain of bacteria that is [[Multi-drug resistant bacteria|multi-drug resistant]].<ref name=Ar2016/> Once clinically stable, intravenous antibiotics should be switched to oral antibiotics.<ref name="Elena 2015"/> For those with ''[[Methicillin resistant Staphylococcus aureus]]'' (MRSA) or ''Legionella'' infections, prolonged antibiotics may be beneficial.<ref name="Elena 2015"/>

The addition of [[corticosteroid]]s to standard antibiotic treatment appears to improve outcomes, reducing death and morbidity for adults with severe community acquired pneumonia, and reducing death for adults and children with non-severe community acquired pneumonia.<ref name=Stern2017>{{cite journal | vauthors = Stern A, Skalsky K, Avni T, Carrara E, Leibovici L, Paul M | title = Corticosteroids for pneumonia | journal = The Cochrane Database of Systematic Reviews | volume = 2017 | pages = CD007720 | date = December 2017 | issue = 12 | pmid = 29236286 | pmc = 6486210 | doi = 10.1002/14651858.CD007720.pub3 }}</ref><ref>{{cite journal |vauthors=Wu WF, Fang Q, He GJ |date=February 2018 |title=Efficacy of corticosteroid treatment for severe community-acquired pneumonia: A meta-analysis |url=https://www.sciencedirect.com/science/article/abs/pii/S0735675717305776 |journal=The American Journal of Emergency Medicine |volume=36 |issue=2 |pages=179–84 |doi=10.1016/j.ajem.2017.07.050 |pmid=28756034 |s2cid=3274763}}</ref> A 2017 review therefore recommended them in adults with severe community acquired pneumonia.<ref name=Stern2017 /> A 2019 guideline however recommended against their general use, unless refractory shock was present.<ref name=Met2019/> Side effects associated with the use of corticosteroids include high blood sugar.<ref name=Stern2017 /> There is some evidence that adding corticosteroids to the standard PCP pneumonia treatment may be beneficial for people who are infected with HIV.<ref name=Ewa2015/>

The use of granulocyte colony stimulating factor (G-CSF) along with antibiotics does not appear to reduce mortality and routine use for treating pneumonia is not supported by evidence.<ref>{{cite journal |vauthors=Cheng AC, Stephens DP, Currie BJ |date=April 2007 |title=Granulocyte-colony stimulating factor (G-CSF) as an adjunct to antibiotics in the treatment of pneumonia in adults |url=https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004400.pub3/full |journal=The Cochrane Database of Systematic Reviews |issue=2 |pages=CD004400 |doi=10.1002/14651858.CD004400.pub3 |pmid=17443546}}</ref>