Pneumococcal infections medical therapy

Jump to navigation Jump to search

Pneumococcal infections Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Pneumococcal infections from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Chest X Ray

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Pneumococcal infections medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Pneumococcal infections medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Pneumococcal infections medical therapy

CDC on Pneumococcal infections medical therapy

Pneumococcal infections medical therapy in the news

Blogs on Pneumococcal infections medical therapy

Directions to Hospitals Treating Pneumococcal infections

Risk calculators and risk factors for Pneumococcal infections medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Medical Therapy

Throughout history, treatment relied primarily on β-lactam antibiotics. In the 1960s, nearly all strains of S. pneumoniae were susceptible to penicillin, but, since that time, there has been an increasing prevalence of penicillin resistance, especially in areas of high antibiotic use. A varying proportion of strains may also be resistant to cephalosporins, macrolides (such as erythromycin), tetracycline, clindamycin and the quinolones. Penicillin-resistant strains are more likely to be resistant to other antibiotics. Most isolates remain susceptible to vancomycin, though its use in a β-lactam-susceptible isolate is less desirable because of tissue distribution of the drug and concerns of development of vancomycin resistance. More advanced beta-lactam antibiotics (cephalosporins) are commonly used in combination with other drugs to treat meningitis and community-acquired pneumonia. In adults, recently developed fluoroquinolones such as levofloxacin and moxifloxacin are often used to provide empiric coverage for patients with pneumonia, but, in parts of the world where these drugs are used to treat tuberculosis, resistance has been described.[1] Susceptibility testing should be routine, with empiric antibiotic treatment guided by resistance patterns in the community in which the organism was acquired, pending the results. There is currently debate as to how relevant the results of susceptibility testing are to clinical outcome.[2][3] There is slight clinical evidence that penicillins may act synergistically with macrolides to improve outcomes.[4]

References

  1. Template:Cite doi
  2. Peterson LR (2006). "Penicillins for treatment of pneumococcal pneumonia: does in vitro resistance really matter?". Clin Infect Dis. 42 (2): 224&ndash, 33. doi:10.1086/497594. PMID 16355333.
  3. Tleyjeh IM, Tlaygeh HM, Hejal R, Montori VM, Baddour LM (2006). "The impact of penicillin resistance on short-term mortality in hospitalized adults with pneumococcal pneumonia: a systematic review and meta-analysis". Clin Infect Dis. 42 (6): 788&ndash, 97. doi:10.1086/500140. PMID 16477555.
  4. Martínez JA, Horcajada JP, Almela M; et al. (2003). "Addition of a Macrolide to a β-Lactam based empirical antibiotic regimen is associated with lower in-hospital mortality for patients with bacteremic pneumococcal pneumonia". Clin Infect Dis. 36 (4): 389–395. doi:10.1086/367541. PMID 12567294.

Template:WH Template:WS