eMedicine Specialties > Radiology > Chest

Pneumonia, Atypical Bacterial: Follow-up

Author: Shakeel Amanullah, MD, Consulting Staff, Pulmonary, Critical Care, and Sleep Medicine, Clarian Arnett Health
Coauthor(s): David H Posner, MD, Assistant Professor of Medicine, New York University School of Medicine; Assistant Chief of Pulmonary Diseases, Instructor, Intensive Care Unit, Education Coordinator for Pulmonary Fellowship, Lenox Hill Hospital; Mina Farhad, MD, PhD, Clinical Instructor of Radiology, New York University School of Medicine; Head of Thoracic Imaging, Department of Radiology, Lenox Hill Hospital; Klaus-Dieter Lessnau, MD, FCCP, Clinical Associate Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory; Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital
Contributor Information and Disclosures

Updated: Mar 7, 2008

Intervention

Legionella pneumonia

Delay in the treatment of Legionella pneumonia is associated with a significantly increased mortality rate.

The newer macrolides, especially azithromycin, have superior in vitro activity, with more intracellular and lung tissue penetration than erythromycin. Quinolones have even greater in vitro activity and better intracellular penetration than the macrolides.

In severely ill patients, rifampin may be used in combination with the macrolides or quinolones.

The duration of therapy is 10-14 days, with a 21-day regimen for immunosuppressed patients or those with extensive disease, as shown on chest radiographs. Chest radiographic findings may continue to deteriorate despite clinical improvement.

Mycoplasma pneumonia

In most cases, recommended treatment for Mycoplasma pneumonia includes tetracycline or a macrolide. Fluoroquinolones also may be used. Two to three weeks of therapy is generally recommended to lessen the risk of relapse.

Chlamydia pneumonia

Chlamydia pneumonia may be treated with doxycycline, a macrolide, or a fluoroquinolone. The preferred diagnostic result is a 4-fold increase in titers from the acute stage to convalescence, with supporting evidence from PCR or culture tests. Therefore, most laboratories cannot confirm the diagnosis in a timely fashion; the treatment of this pneumonia should be empirical.


 


More on Pneumonia, Atypical Bacterial

Overview: Pneumonia, Atypical Bacterial
Imaging: Pneumonia, Atypical Bacterial
Follow-up: Pneumonia, Atypical Bacterial
Multimedia: Pneumonia, Atypical Bacterial
References
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References

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Further Reading

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Keywords

walking pneumonia, atypical pneumonia, Legionella pneumonia, Chlamydia pneumonia, Mycoplasma pneumonia, Mycobacterium tuberculosis, community-acquired pneumonia, CAP, Legionnaires disease, Legionnaire's disease, Legionnaires' disease, Legionella pneumophila, Legionella micdadei, Mycoplasma hominis, Ureaplasma urealyticum, Chlamydia psittaci, Chlamydia trachomatis, Chlamydia pneumoniae, TWAR agent

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Contributor Information and Disclosures

Author

Shakeel Amanullah, MD, Consulting Staff, Pulmonary, Critical Care, and Sleep Medicine, Clarian Arnett Health
Shakeel Amanullah, MD is a member of the following medical societies: American College of Chest Physicians, American Thoracic Society, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

David H Posner, MD, Assistant Professor of Medicine, New York University School of Medicine; Assistant Chief of Pulmonary Diseases, Instructor, Intensive Care Unit, Education Coordinator for Pulmonary Fellowship, Lenox Hill Hospital
Disclosure: Nothing to disclose.

Mina Farhad, MD, PhD, Clinical Instructor of Radiology, New York University School of Medicine; Head of Thoracic Imaging, Department of Radiology, Lenox Hill Hospital
Mina Farhad, MD is a member of the following medical societies: Radiological Society of North America
Disclosure: Nothing to disclose.

Klaus-Dieter Lessnau, MD, FCCP, Clinical Associate Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory; Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital
Klaus-Dieter Lessnau, MD, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Medical Association, American Society for Artificial Internal Organs, American Thoracic Society, Physicians for Social Responsibility, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Medical Editor

Satinder P Singh, MD, Associate Professor of Radiology, Chief of Cardiopulmonary Radiology, Director of Cardiac CT, Director of Combined Cardiopulmonary and Abdominal Radiology, Department of Radiology, University of Alabama at Birmingham
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Eric J Stern, MD, Professor of Radiology, Adjunct Professor of Medicine, Adjunct Professor of Medical Education and Biomedical Informatics, University of Washington School of Medicine; Director of Thoracic Imaging, Harborview Medical Center; Associate Medical Staff, Seattle Cancer Care Alliance
Eric J Stern, MD is a member of the following medical societies: American Roentgen Ray Society, Association of University Radiologists, European Society of Radiology, Radiological Society of North America, and Society of Thoracic Radiology
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Kavita Garg, MD, Professor, Department of Radiology, University of Colorado Health Sciences Center
Kavita Garg, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, Radiological Society of North America, and Society of Thoracic Radiology
Disclosure: Nothing to disclose.

 
 
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