My boyfriend was told today that he has double pneumonia. He is running a fever of 103 and is on medications, but he's having a hard time keeping them down due to vomiting. How serious is double pneumonia? At what point should he be hospitalized?

Rebecca

Pneumonia means infection of the lung. "Double pneumonia" is the common term for pneumonia involving both lungs. It indicates a serious infection, but it does not tell us what organism is causing the pneumonia. Certain microbes, such as Mycoplasma pneumoniae, usually do not cause fatal disease, even if they involve both lungs. Conversely, some pathogens, such as the bacterium Streptococcus pneumoniae (also called "pneumococcus") can cause severe blood infection and death while only involving a single lung.

Several factors may prompt a physician to consider hospitalizing a patient with pneumonia. These include, but are not limited to, the following:

• Age over 65, because the death rate for pneumonia is higher for older people.
• Low blood pressure, which is a sign of systemic (whole-body) infection.
  

• Low level of oxygen in the blood.
  
• Pneumonia in both lungs.
  
• Significant underlying disease or immune suppression.
  
• Confusion, which is also a sign of systemic infection.
  
• Unreliable follow-up care, such as may be seen with the homeless or mentally ill.
  
• Vomiting that makes the patient unable to take oral medication.
  
• Your boyfriend has at least two of the above risk factors. If he were my patient in my office, and if I did not think he was ill enough to admit him to the hospital, I would consider giving him parenteral (intramuscular or intravenous) injections of antibiotics in my office. That would ensure he received an adequate dose of medication. I could then see him in my office every day until he is well. I could give him the antibiotics in my office each day, or I could arrange for a nurse to give him antibiotics in his home. However, if I had any concerns about him being at home, I would certainly admit him to the hospital.