What is the best oral antibiotic for streptococcal pneumonia?

From the Guidelines

Amoxicillin is the preferred oral antibiotic for treating streptococcal pneumonia in patients who can be managed as outpatients, with a dosage of 90 mg/kg/day in 2 doses for children and 500-875 mg twice daily for adults. This recommendation is based on the guidelines provided by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America, as outlined in the study published in Clinical Infectious Diseases in 2011 1. The study suggests that amoxicillin is effective against Streptococcus pneumoniae, including strains with penicillin MICs >2.0 μg/mL.

For patients with penicillin allergy, alternative options include:

• Macrolides such as azithromycin (10 mg/kg on day 1, followed by 5 mg/kg/day once daily on days 2–5) or clarithromycin (15 mg/kg/day in 2 doses) for children, and azithromycin (500 mg on day 1, then 250 mg daily for 4 more days) or clarithromycin (500 mg twice daily for 7-14 days) for adults
• Doxycycline (100 mg twice daily for 7-10 days) for adults with allergies
• Oral clindamycin (30-40 mg/kg/day in 3 doses) or oral linezolid (30 mg/kg/day in 3 doses for children <12 years and 20 mg/kg/day in 2 doses for children ≥12 years) for patients with severe penicillin allergy or resistance to other antibiotics, as suggested in the guidelines 1.

It is essential to note that patients should complete the full course of antibiotics even if symptoms improve, stay hydrated, rest adequately, and seek immediate medical attention if symptoms worsen or don't improve within 48-72 hours of starting treatment. The choice of antibiotic should be guided by local susceptibility data and the severity of the infection.

From the FDA Drug Label

Azithromycin has only been shown to be safe and effective in the treatment of community-acquired pneumonia due to Chlamydia pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae or Streptococcus pneumoniae in patients appropriate for oral therapy Community-acquired pneumonia due to Chlamydophila pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae or Streptococcus pneumoniae in patients appropriate for oral therapy

The best oral antibiotic for streptococcal pneumonia is azithromycin 2, as it has been shown to be safe and effective in the treatment of community-acquired pneumonia due to Streptococcus pneumoniae in patients appropriate for oral therapy.

• Key points:
  • Azithromycin should not be used in patients with pneumonia who are judged to be inappropriate for oral therapy because of moderate to severe illness or risk factors.
  • Susceptibility tests should be performed when patients are treated with azithromycin to ensure the bacteria are susceptible to the antibiotic.
• Important consideration: Azithromycin should only be used to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria.

From the Research

Oral Antibiotics for Streptococcal Pneumonia

• The choice of oral antibiotic for streptococcal pneumonia depends on various factors, including the severity of the infection, the patient's medical history, and the presence of drug-resistant strains 3, 4.
• Amoxicillin/clavulanic acid (Augmentin) is a broad-spectrum antibiotic that has been shown to be effective against streptococcal pneumonia, including drug-resistant strains 3, 4.
• Other oral antibiotics, such as clarithromycin and moxifloxacin, have also been shown to be effective in treating community-acquired pneumonia, including streptococcal pneumonia 5, 6, 7.
• The efficacy and safety of these antibiotics have been compared in several studies, with results showing that they are generally similar in terms of clinical cure rates and adverse event profiles 5, 6, 7.

Comparison of Oral Antibiotics

• A study comparing amoxicillin/clavulanic acid with clarithromycin found that both antibiotics had high clinical cure rates (92% and 91%, respectively) and similar adverse event profiles 6.
• Another study comparing moxifloxacin with clarithromycin found that moxifloxacin had a slightly higher observed cure rate, but this was not statistically significant 7.
• A study evaluating the efficacy of amoxicillin/clavulanic acid against drug-resistant streptococcal pneumonia found that the antibiotic was effective in treating infections caused by penicillin-resistant strains 3.

Considerations for Treatment

• The choice of oral antibiotic for streptococcal pneumonia should be based on the patient's individual needs and the presence of drug-resistant strains in the community 3, 4.
• The use of broad-spectrum antibiotics, such as amoxicillin/clavulanic acid and moxifloxacin, may be justified in cases where the infection is severe or the patient is at high risk of complications 3, 7.
• The potential for adverse events and drug interactions should also be considered when selecting an oral antibiotic for streptococcal pneumonia 5, 6, 7.