Streptococcus pneumonia

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  • Streptococcus pneumonia treatment
  • 1. Lung (Community-acquired pneumonia)[1]
  • 1.1 Penicillin sensitive (minimum inhibitory concentration < 2 mcg/ml)
  • Preferred regimen: Penicillin G 5-24 MU IV in equally divided doses q4-6h, Amoxicillin 1 g PO tid (+/- macrolide)
  • Alternative regimen: Macrolides (Azithromycin (IV) 500 mg IV qd for at least 2 days followed by 500 mg PO qd 7-10 days or Clarithromycin extended-release tablets 1000 mg PO qd for 7 days) and oral Cephalosporins-Cefpodoxime 200 mg PO bd, (Cefprozil 500 mg PO bd, Cefditoren 400 mg PO bd, Cefdinir 300 mg PO bd), OR parenteral Cephalosporins-Ceftriaxone 2 g IV q24h (or Cefotaxime 1-2 g IV q6-8h), Clindamycin 600-1200 mg IV/IM q6-12h, do not give single IM doses > 600 mg; IV infusion rates should not exceed 30 mg/min , Doxycycline 100 mg PO bd, respiratory flouroquniolones.
  • 2.Endocarditis[2]
  • Preferred regimen (1): Aqueous crystalline Penicillin-G 6 MU q4-6h IV for 4 weeks
  • Preferred regimen (2) (who are unable to tolerate beta lactams therapy): Vancomycin 15 mg/kg IV q12h (target trough concentration, 10-15 mcg/mL); for troughs of 15-20 mcg/mL (MIC, 1 mcg/mL or less), 15-20 mg/kg (actual body weight) IV q8-12h for most patients with normal renal function
  • Preferred regimen (3) (If the isolate is resistant (MIC 2 g/mL) to cefotaxime): Cefotaxime 1-2 g q8-12h IV/IM (max dose: 12 g/24 hr) AND Vancomycin 15 mg/kg/day IV q12h AND Rifampin 300 mg IV/PO q8h for 6 weeks, in combination with appropriate antimicrobial therapy
  • Alternative regimen (1): Cefazolin 0.5-2 g q8h IV/IM (max dose: 12 g/24 hr)
  • Alternative regimen (2): Ceftriaxone 2 g IV q12h
  • Note : Streptococcus pneumoniae with intermediate doses minimum inhibitory concentration (MIC) 0.12 g/mL–0.5 g/mL Penicillin resistance (MIC 0.1 to 1.0 g/mL) or high Penicillin resistance (MIC 2.0 g/mL) is being recovered from patients with bacteremia.
  • 3. Sinuses (sinusitis)[3]
  • Empiric therapy
  • 3.1 For initial empiric treatment of acute bacterial rhinosinusitis in adults
  • 3.2 For second-line high-dose therapy for acute bacterial rhinosinusitis in adults
  • Preferred regimen: Amoxicillin 2 g/Clavulanate 125 mg PO bid recommended by the Infectious Disease Society of America (IDSA).
  • Note: The second line high dose therapy is recommended in adults who have failed initial therapy, in regions of high endemic rates (10% or greater) of invasive Penicillin-nonsusceptible Streptococcus pneumoniae, severe infection.
  • 4. Bronchi (acute exacerbation of chronic bronchitis)[4]
  • Preferred regimen (1): Amoxicillin 875 mg PO q12h or 500 mg PO q8h
  • Preferred regimen (2): Doxycycline 100 mg PO q12h
  • 5. CNS (meningitis)[5]
  • Empiric therapy
Note: Middle ear infections (otitis media), peritoneum infections (spontaneous bacterial peritonitis), pericardium infections (purulent pericarditis), skin infections (cellulitis) and eye infections (conjunctivitis) caused by Streptococcus pneumonia.
  • Prevention
  • 1. Pneumovax (23-valent) prevents bacteremia; impact on rates of CAP are modest or nil.
  • 2. Prevnar vaccine for children <2 yrs age prevents invasive pneumococcal infection in adults by herd effect. Impact is impressive with rates of invasive pneumococcal infection down 80% in peds and 20-40% in adults.
  • 3. Risk for bacteremia in splenectomy, HIV, smokers, black race, multiple myeloma, asthma.


  1. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC; et al. (2007). "Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults". Clin Infect Dis. 44 Suppl 2: S27–72. doi:10.1086/511159. PMID 17278083.
  2. Baddour LM, Wilson WR, Bayer AS, Fowler VG, Bolger AF, Levison ME; et al. (2005). "Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America". Circulation. 111 (23): e394–434. doi:10.1161/CIRCULATIONAHA.105.165564. PMID 15956145.
  3. Chow AW, Benninger MS, Brook I, Brozek JL, Goldstein EJ, Hicks LA; et al. (2012). "IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults". Clin Infect Dis. 54 (8): e72–e112. doi:10.1093/cid/cir1043. PMID 22438350.
  4. Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  5. Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM; et al. (2004). "Practice guidelines for the management of bacterial meningitis". Clin Infect Dis. 39 (9): 1267–84. doi:10.1086/425368. PMID 15494903.