General principles

Specific antimicrobial therapy may be supplemented by:

• oxygen for hypoxia; ventilation in severe hypoxia. 35% oxygen is administered, but if previous CO2 retention is suspected then 24-28% should be used and arterial blood gases monitored.
• fluids for dehydration
• analgesics - NSAIDs and paracetamol - for mild pleuritic pain; more potent analgesics such as morphine if pain is severe - but beware hypercapnia.
• supervised coughing and, later, chest physiotherapy to encourage expectoration is valuable. Nebulised saline may help expectoration.

Routes of administration:

• severe cases - parenteral
• change to oral treatment when there is a clinical improvement
• mild or moderate - oral route usually satisfactory

Duration of treatment:

• 7 to 10 days is usually sufficient. Continue for at least 3 days after the fever has settled. But:
• staph aureus and Klebsiella - continue until temperature is consistently normal, then continue for 2 weeks.
• mycoplasma - 2 to 3 weeks.