From the Guidelines
The treatment for pneumococcal pneumonia is typically with antibiotics, such as a β-lactam plus macrolide combination or a respiratory fluoroquinolone alone.
Treatment Options
- For outpatient treatment, amoxicillin is the preferred antibiotic for oral treatment of pneumococcal pneumonia involving susceptible strains 1.
- For hospitalized patients, cefotaxime or ceftriaxone are the preferred parenteral agents for treatment of pneumococcal pneumonia without meningitis for strains with reduced susceptibility to penicillin but with MICs of cefotaxime or ceftriaxone of ≤2 mg/mL 1.
- Respiratory fluoroquinolones, such as moxifloxacin, gatifloxacin, levofloxacin, or gemifloxacin, are also effective against pneumococcal pneumonia, including penicillin-resistant strains 1.
Considerations
- The choice of antibiotic should be based on the patient's severity of illness, underlying health conditions, and local susceptibility patterns 1.
- Combination therapy with a β-lactam plus a macrolide or a respiratory fluoroquinolone may be used for patients who are sufficiently ill to require hospitalization 1.
- Penicillin susceptibility should be determined to guide treatment, with penicillin-susceptible strains treated with a β-lactam alone and penicillin-resistant strains treated with cefotaxime, ceftriaxone, or a respiratory fluoroquinolone 1.
From the Research
Treatment Options for Pneumococcal Pneumonia
- The treatment for pneumococcal pneumonia includes the use of antibiotics such as macrolides, beta-lactams, and quinolones 2.
- Penicillin G is also a recommended treatment option, with a continuous infusion of 20-24 million units per day providing effective serum levels against most penicillin-resistant Streptococcus pneumoniae (PRSP) strains 3.
- In cases of severe infections, such as bacterial meningitis, the addition of vancomycin to a third-generation cephalosporin is advisable while awaiting laboratory test results 4.
- For empiric therapy of bacteraemic pneumococcal pneumonia, the combination of beta-lactams and macrolides is recommended 5.
- Adjunctive therapies, such as corticosteroids and cyclic adenosine monophosphate-elevating agents, may also be useful in decreasing mortality 6.
Antibiotic Resistance and Treatment
- The emergence of antibiotic-resistant Streptococcus pneumoniae strains is a concern, with resistance affecting various classes of drugs, including beta-lactams, macrolides, and fluoroquinolones 6, 4.
- New alternative molecules, such as fluoroquinolones, streptogramins, and oxazolidinones, have shown efficacy against penicillin-resistant pneumococci 4.
- The use of polysaccharide or conjugated vaccines is highly recommended to prevent pneumococcal infections 4, 5.