What is the treatment for inpatient Streptococcus pneumoniae (strep pneumo) pneumonia?

From the Guidelines

For inpatient treatment of Streptococcus pneumoniae pneumonia, the recommended first-line therapy is ampicillin or penicillin G, with alternatives being ceftriaxone or cefotaxime, as stated in the guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America 1. When considering treatment options, it's essential to note that the choice of antibiotic should be based on the patient's immunization status and local penicillin resistance patterns.

• For fully immunized patients with minimal local penicillin resistance, ampicillin or penicillin G are suitable options.
• For patients who are not fully immunized or have significant local penicillin resistance, ceftriaxone or cefotaxime are recommended, with the addition of vancomycin or clindamycin for suspected community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) 1. In addition to these recommendations, it's crucial to consider the patient's clinical response and adjust treatment accordingly.
• Treatment duration should be guided by clinical improvement, including resolution of fever, improved respiratory symptoms, and hemodynamic stability.
• Oxygen supplementation should be provided to maintain oxygen saturation above 90%.
• Once the patient shows improvement, transition to oral antibiotics can be considered, with the choice of antibiotic depending on the patient's specific needs and susceptibility patterns 1.

From the FDA Drug Label

Azithromycin for Injection, USP is indicated for the treatment of patients with infections caused by susceptible strains of the designated microorganisms in the conditions listed below... Community-acquired pneumonia due to Chlamydia pneumoniae, Haemophilus influenzae, Legionella pneumophila, Moraxella catarrhalis, Mycoplasma pneumoniae, Staphylococcus aureus, or Streptococcus pneumoniae in patients who require initial intravenous therapy 2 Ceftriaxone for Injection is indicated for the treatment of the following infections when caused by susceptible organisms: LOWER RESPIRATORY TRACT INFECTIONS Caused by Streptococcus pneumoniae... 3

The treatment for inpatient Streptococcus pneumoniae (strep pneumo) pneumonia includes:

• Azithromycin (IV) as initial therapy, followed by oral azithromycin as required 2
• Ceftriaxone (IV) as an alternative option for the treatment of lower respiratory tract infections caused by Streptococcus pneumoniae 3

From the Research

Treatment Options for Inpatient Streptococcus pneumoniae Pneumonia

• The treatment for inpatient Streptococcus pneumoniae pneumonia can involve various antibiotics, including cefotaxime, ceftriaxone, azithromycin, and levofloxacin 4, 5.
• A study comparing cefotaxime and ceftriaxone found that both were effective in treating patients with uncomplicated community-acquired pneumonia, with a clinical cure rate of 98% 4.
• Another study found that the combination of ceftriaxone and azithromycin was more effective than levofloxacin in eradicating Streptococcus pneumoniae, with a 100% eradication rate compared to 44% for levofloxacin 5.

Antibiotic Resistance and Treatment

• The emergence of antibiotic-resistant Streptococcus pneumoniae strains has made treatment more complicated, but most patients with mild to moderate pneumococcal pneumonia may still respond to oral amoxicillin, and those with severe pneumonia may be successfully treated with intravenous ceftriaxone, cefotaxime, or amoxicillin-clavulanic acid 6.
• Macrolide-resistant pneumococci may not respond to therapy with a macrolide, and alternative treatments should be considered 6.
• A review of the literature found that in vitro resistance to penicillin-class antibiotics does not necessarily predict treatment failure, and beta-lactam antibiotics remain a recommended treatment option for community-acquired pneumonia 7.

Transition to Oral Antibiotics

• Guidelines recommend switching from intravenous to oral antibiotics once patients achieve clinical stability, but the selection of an oral antibiotic for patients with health care-associated pneumonia is not well-guided 8.
• A study found that transitioning to narrow-spectrum oral antibiotics (usually a β-lactam) was safe and effective for hospitalized patients with health care-associated pneumonia, with similar outcomes to broad-spectrum oral antibiotics (fluoroquinolone) 8.