How do you manage immunosuppressive medications in patients who develop a pneumonia?

For most bacterial pneumonia in transplant patients, I prefer to avoid changing immunosuppressives and simply administer appropriate antibiotic therapy. This approach is effective and minimizes the risk of triggering acute rejection.

For viral etiologies, I will often reduce or hold cell cycle inhibitors and slightly increase corticosteroids to the equivalent of prednisone 0.5 mg/kg/day. This may allow better anti-viral response by the immune system while reducing lung inflammation caused by vi...