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What Causes Fever, Headache And Cough While Treating Bacterial Pneumonia?
Question: I came down with bacterial pneumonia and finished antibiotics on the 30th of December. I'm starting get low grade fevers, headache, and am still coughing. When I lay on my back I can hear bubbling in my chest. I heard this when I had Pneumonia but it went away after I finished my antibiotics. My husband (a 4th year medical student) can't hear any crackling in my lungs anymore with his stethoscope but I know sometimes you can have pneumonia and not hear it. Should I have another chest x-ray? Could I be relapsing? My four year old also was diagnosed with pneumonia last Thursday. She's on her 4th full day of antibiotics but still has a low grade fever and my husband can hear only a little crackling in her lungs in comparison to where she started. Her pulse ox has increased from 90 to a steady 95, but I feel her fever should be gone by now. Do we both need different antibiotics?
Brief Answer:
could be a relapse... daughter probably needs more time
Detailed Answer:
Hello,
there are no 100% safe answers for this but there are ways to approach it diagnostically. Having fever and other symptoms (besides cough which may persist for a long time) after the infection usually means either incomplete treatment or relapse. A new infection cannot be excluded either. If you were OK (no fever, feeling better) for a few days and then fever and other symptoms started all over again then another X-ray could help. The "old" pneumonia should still be there because it needs more time to resolve in the X-ray but either a reduction in size or a new focus of infection (despite the lack of auscultatory findings) could provide helpful clues. Another way to get clues is by doing lab tests. A complete blood count and C-reactive protein can be helpful. A high white blood cell count and high C-RP would indicate active bacterial infection. Vital signs also provide clues. Fast heart rate is consistent with an active infection.
Regarding your daughter, assessment can be done the same way. 4 days can be little time in pneumonia and we should also consider the possibility of viral pneumonia (where antibiotics have no effect). If there are signs of improvement (like lower fever or other findings) then you can wait. I wouldn't consider the slight elevation in heart rate very important because 95 is not that high for a 4 years old. Lab tests may help to document her progress. The same tests can be used.
Regarding treatment, without culture results you can never know. Empiric treatment (a clinically educated guess that is) should be given. In your case, if you had a high CRP value and symptoms of active infection I would have prescribed more 'advanced' treatment (like a quinolone) since you've already got adequate 1st line treatment (I suppose...).
I hope you find my comments helpful!
Kind Regards!
could be a relapse... daughter probably needs more time
Detailed Answer:
Hello,
there are no 100% safe answers for this but there are ways to approach it diagnostically. Having fever and other symptoms (besides cough which may persist for a long time) after the infection usually means either incomplete treatment or relapse. A new infection cannot be excluded either. If you were OK (no fever, feeling better) for a few days and then fever and other symptoms started all over again then another X-ray could help. The "old" pneumonia should still be there because it needs more time to resolve in the X-ray but either a reduction in size or a new focus of infection (despite the lack of auscultatory findings) could provide helpful clues. Another way to get clues is by doing lab tests. A complete blood count and C-reactive protein can be helpful. A high white blood cell count and high C-RP would indicate active bacterial infection. Vital signs also provide clues. Fast heart rate is consistent with an active infection.
Regarding your daughter, assessment can be done the same way. 4 days can be little time in pneumonia and we should also consider the possibility of viral pneumonia (where antibiotics have no effect). If there are signs of improvement (like lower fever or other findings) then you can wait. I wouldn't consider the slight elevation in heart rate very important because 95 is not that high for a 4 years old. Lab tests may help to document her progress. The same tests can be used.
Regarding treatment, without culture results you can never know. Empiric treatment (a clinically educated guess that is) should be given. In your case, if you had a high CRP value and symptoms of active infection I would have prescribed more 'advanced' treatment (like a quinolone) since you've already got adequate 1st line treatment (I suppose...).
I hope you find my comments helpful!
Kind Regards!
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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