From the Guidelines
Pneumococcal pneumonia treatment should be initiated with a beta-lactam antibiotic, such as penicillin G or amoxicillin, or a respiratory fluoroquinolone, such as moxifloxacin or levofloxacin, depending on the patient's susceptibility and local resistance patterns.
Treatment Options
- For outpatient treatment, a macrolide (e.g., azithromycin, clarithromycin) or doxycycline can be used for previously healthy patients without risk factors for drug-resistant Streptococcus pneumoniae (DRSP) infection 1.
- For patients with comorbidities or recent antibiotic therapy, a respiratory fluoroquinolone (e.g., moxifloxacin, gemifloxacin, or levofloxacin) or a combination of a beta-lactam (e.g., high-dose amoxicillin or amoxicillin-clavulanate) and a macrolide can be used 1.
- For inpatient treatment, a beta-lactam plus a macrolide or a respiratory fluoroquinolone alone can be used for patients without recent antibiotic therapy, while a combination of a beta-lactam and a macrolide or a respiratory fluoroquinolone alone can be used for patients with recent antibiotic therapy 1.
Specific Antibiotics
- Amoxicillin is the preferred oral antibiotic for susceptible strains of S. pneumoniae, but high dosages (3-4 g/day) are required to achieve activity against 90% of S. pneumoniae strains 1.
- Fluoroquinolones (e.g., moxifloxacin, levofloxacin) are active against 98% of S. pneumoniae strains, including penicillin-resistant strains, but their use is limited due to concerns about increasing resistance 1.
- Macrolides (e.g., azithromycin, clarithromycin) are active against most common pathogens, including atypical agents, but macrolide resistance is reported for 20-30% of S. pneumoniae strains 1.
Considerations
- The choice of antibiotic should be based on the patient's susceptibility and local resistance patterns, as well as the presence of comorbidities or recent antibiotic therapy 1.
- The use of fluoroquinolones should be limited due to concerns about increasing resistance, and alternative antibiotics should be considered when possible 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.