From the Guidelines
The treatment for pneumonia caused by Streptococcus pneumoniae typically involves antibiotics, with the specific choice depending on the severity of illness, patient factors, and local resistance patterns, and according to the most recent guidelines, a fluoroquinolone or a combination of a beta-lactam plus a macrolide is often recommended for hospitalized patients 1.
Treatment Options
- For outpatients with community-acquired pneumonia, a macrolide, doxycycline, or a fluoroquinolone with enhanced activity against S. pneumoniae is recommended 1.
- For patients who are hospitalized, a fluoroquinolone alone or an extended-spectrum cephalosporin (such as cefotaxime or ceftriaxone) plus a macrolide is recommended 1.
- For patients hospitalized in the intensive care unit (ICU), ceftriaxone, cefotaxime, ampicillin-sulbactam, or piperacillin-tazobactam in combination with a fluoroquinolone or macrolide is recommended 1.
Key Considerations
- The choice of antibiotic should be based on the severity of illness, patient factors, and local resistance patterns 1.
- Patients should complete the full course of antibiotics even if symptoms improve quickly 1.
- Supportive care, including adequate hydration, rest, and fever control with acetaminophen or ibuprofen, is also important 1.
Recent Guidelines
- The Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) have published guidelines for the management of community-acquired pneumonia in adults, which recommend a fluoroquinolone or a combination of a beta-lactam plus a macrolide for hospitalized patients 1.
- The Pediatric Infectious Diseases Society and the IDSA have also published guidelines for the management of community-acquired pneumonia in infants and children older than 3 months of age, which recommend amoxicillin or a macrolide for outpatients and a beta-lactam plus a macrolide for hospitalized patients 1.
From the FDA Drug Label
Azithromycin Tablets, USP are indicated for the treatment of patients with mild to moderate infections (pneumonia: see WARNINGS) caused by susceptible strains of the designated microorganisms in the specific conditions listed below Community-acquired pneumonia due to Chlamydophila pneumoniae, Haemophilus influenzae, Mycoplasia pneumoniae or Streptococcus pneumoniae in patients appropriate for oral therapy
The treatment for pneumonia (Streptococcus pneumoniae) is azithromycin (PO), but only for patients with mild to moderate infections and who are appropriate for oral therapy. Patients with moderate to severe illness or certain risk factors should not be treated with azithromycin 2.
From the Research
Treatment Options for Pneumonia (Streptococcus pneumoniae)
- The treatment for pneumonia (Streptococcus pneumoniae) can involve various antibiotic regimens, including levofloxacin monotherapy or a combination of azithromycin and ceftriaxone 3, 4.
- Studies have compared the efficacy and tolerability of these regimens, with results showing that levofloxacin monotherapy can be as effective as the combination regimen in hospitalized adults with moderate to severe community-acquired pneumonia (CAP) 3.
- However, another study found that the combination of ceftriaxone and azithromycin may be preferred over levofloxacin monotherapy to minimize the development of multiresistant nosocomial Gram-negative bacilli 4.
- A more recent study compared levofloxacin with a combination of ceftriaxone and azithromycin for treating mild to moderate CAP, finding that levofloxacin improved patients' signs and symptoms and reduced hospitalization length, with a similar rate of side effects 5.
Antibiotic Resistance and Treatment Considerations
- The use of broad-spectrum antimicrobials for the treatment of pneumonia in seriously ill patients can maximize clinical outcomes, but it also poses a risk of selecting resistant organisms 6.
- Narrow-spectrum agents can be as effective as broad-spectrum agents and may result in less collateral damage, such as superinfection by resistant pathogens or selection of antibiotic resistance 7.
- Empirical antimicrobial therapy for pneumonia should be initiated promptly and should have a broad spectrum that covers all potential antimicrobial-resistant pathogens, with the option to streamline or de-escalate therapy based on microbiological data and clinical response 6.