What does a lack of response to treatment for bacterial pneumonia suggest?

Updated: Sep 30, 2020
  • Author: Justina Gamache, MD; Chief Editor: Guy W Soo Hoo, MD, MPH  more...
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Answer

Pneumonia that does not respond to treatment poses a clinical dilemma and is a common concern. If patients do not improve within 72 hours, an organism that is not susceptible or is resistant to the initial empiric antibiotic regimen should be considered. Lack of response may also be secondary to a complication such as empyema or abscess formation.

Also consider broadening the differential diagnosis to include noninfectious etiologies such as malignancies, inflammatory conditions, or congestive heart failure. In patients in whom the precipitating factor is airway obstruction by a neoplasm or a foreign body, the post-obstructive infiltrate may fail to clear. Computed tomography (CT) scanning may be helpful in unclear cases and in delineating more complex pulmonary processes. Carefully review the patient's medical history, especially in regard to potential inhaled respiratory exposure. See Diagnosis.


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