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.
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