What is the recommended treatment for Streptococcus pneumoniae infections?

From the Guidelines

The recommended treatment for Streptococcus pneumoniae infections typically involves antibiotics, with penicillin being the traditional first-line therapy for susceptible strains, but due to increasing antibiotic resistance, the most recent guidelines recommend using a respiratory fluoroquinolone or a combination of a β-lactam plus a macrolide for outpatient treatment, as stated in the 2007 guidelines by the Infectious Diseases Society of America/American Thoracic Society 1. For non-severe infections in adults, amoxicillin 500-875 mg three times daily for 7-10 days is often prescribed, but for more severe infections like pneumonia, intravenous antibiotics may be necessary, such as ceftriaxone 1-2 g daily. In cases of penicillin allergy, alternatives include macrolides (azithromycin 500 mg on day 1, then 250 mg daily for 4 days) or respiratory fluoroquinolones (levofloxacin 750 mg daily for 5 days), as recommended in the 2005 European Respiratory Journal guidelines 1. Due to increasing antibiotic resistance, susceptibility testing is important to guide therapy, as emphasized in the 2003 Clinical Infectious Diseases guidelines 1. For invasive infections like meningitis, higher doses of antibiotics that penetrate the blood-brain barrier are required, often combining ceftriaxone with vancomycin until susceptibility results are available, as stated in the 2003 Clinical Infectious Diseases guidelines 1. Some key points to consider when treating Streptococcus pneumoniae infections include:

• The importance of early treatment to prevent rapidly progressive disease, particularly in immunocompromised patients, the elderly, and young children.
• The need for susceptibility testing to guide therapy due to increasing antibiotic resistance.
• The use of supportive care, including oxygen therapy, fluid management, and fever control, in addition to antibiotic treatment.
• The consideration of alternative antibiotics, such as macrolides or respiratory fluoroquinolones, in cases of penicillin allergy or resistance. It is essential to follow the most recent guidelines and consider the specific circumstances of each patient when determining the best course of treatment for Streptococcus pneumoniae infections, as recommended by the 2015 American Heart Association guidelines 1.

From the FDA Drug Label

Levofloxacin tablets are indicated for the treatment of community-acquired pneumonia due to methicillin-susceptible Staphylococcus aureus, Streptococcus pneumoniae (including multi-drug-resistant Streptococcus pneumoniae [MDRSP]), Haemophilus influenzae, Haemophilus parainfluenzae, Klebsiella pneumoniae, Moraxella catarrhalis, Chlamydophila pneumoniae, Legionella pneumophila, or Mycoplasma pneumoniae Levofloxacin tablets are indicated for the treatment of acute bacterial sinusitis due to Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis Levofloxacin tablets are indicated for the treatment of acute bacterial exacerbation of chronic bronchitis due to methicillin-susceptible Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, Haemophilus parainfluenzae, or Moraxella catarrhalis

The recommended treatment for Streptococcus pneumoniae infections is levofloxacin.

• Community-acquired pneumonia: levofloxacin is indicated for the treatment of community-acquired pneumonia due to Streptococcus pneumoniae (including multi-drug-resistant Streptococcus pneumoniae [MDRSP]) 2.
• Acute bacterial sinusitis: levofloxacin is indicated for the treatment of acute bacterial sinusitis due to Streptococcus pneumoniae 2.
• Acute bacterial exacerbation of chronic bronchitis: levofloxacin is indicated for the treatment of acute bacterial exacerbation of chronic bronchitis due to Streptococcus pneumoniae 2.

From the Research

Treatment Options for Streptococcus pneumoniae Infections

• The recommended treatment for Streptococcus pneumoniae infections depends on the severity of the infection and the susceptibility of the strain to antibiotics 3, 4, 5.
• For mild to moderate pneumococcal pneumonia, oral amoxicillin may be effective, while severe pneumonia may require intravenous ceftriaxone, cefotaxime, or amoxicillin-clavulanic acid 5.
• In cases of penicillin-resistant pneumococci, alternative antibiotics such as levofloxacin, gatifloxacin, moxifloxacin, cefepime, meropenem, vancomycin, or linezolid may be used 3, 4.
• Combination therapy with a beta-lactam and a fluoroquinolone or macrolide may also be effective, although synergy and antagonism can occur depending on the specific combination and strain susceptibility 6.

Considerations for Penicillin-Resistant Strains

• Penicillin resistance is defined as a minimum inhibitory concentration (MIC) of 2 microg/mL or more, while intermediate resistance is defined as an MIC of 1-2 microg/mL 3.
• Treatment of penicillin-resistant pneumococci requires careful selection of antibiotics with adequate cerebrospinal fluid penetration and favorable kill ratios, particularly in cases of meningitis 3, 4.
• Vancomycin or chloramphenicol may be alternative options for the treatment of relatively resistant Streptococcus pneumoniae infections, but antibiotic sensitivities should be determined for each isolate to ensure susceptibility 7.

Importance of Antibiotic Selection and Stewardship

• Clinicians should be selective in antibiotic selection to minimize further decreases in penicillin susceptibility to S. pneumoniae 3.
• The use of low-resistance potential antibiotics, such as respiratory quinolones, clindamycin, and doxycycline, may help to reduce the development of resistance 3, 4.
• Macrolides as monotherapy or as part of combination therapy should be minimized due to the risk of resistance development 3, 6.