Streptococcus pneumoniae infection

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Streptococcus pneumoniae
SEM micrograph of S. pneumoniae.
Scientific classification
Domain: Bacteria Phylum: Firmicutes Class: Diplococci Order: Lactobacillales Family: Streptococcaceae Genus: Streptococcus Species: S. pneumoniae
Binomial name
Streptococcus pneumoniae (Klein 1884) Chester 1901

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

Diagnosis

History & Symptoms | Physical Examination | Lab Tests | Chest X Ray | CT | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Antimicrobial therapy

• Streptococcus pneumonia

• (1) Lung (pneumonia)

• Community-acquired pneumonia

• Penicillin sensitive (minimum inhibitory concentration ≤ 2)

• Preferred regimen: Penicillin G 1-2 MU q6h IV OR Ceftriaxone 2 g IV q24h OR Cefotaxime 1-2 g IV q6-8h.

Oral agents: Penicillin V 500 mg PO qid, Amoxicillin 500-1000 mg PO tid, Cefpodoxime 200 mg PO bd, Cefprozil 500 mg PO bd, Cefditoren 400 mg PO bd, Cefdinir 300 mg PO bd, OR Doxycycline 100 mg PO bd.

• Penicillin-resistant (Penicillin minimum inhibitory concentration >8)

• Preferred regimen:: Levofloxacin (Levaquin) 750 mg OR Moxifloxacin (Avelox) 400 mg IV/PO q24h, Telithromycin (Ketek) 800 mg PO qd, Ceftriaxone IV, Cefotaxime IV, Vancomycin 15 mg/kg IV q12h OR Linezolid 600 mg IV/PO q12h.

• (2)Sinuses (sinusitis)

• Sinusitis (empiric therapy)

• Preferred regimen: amoxicillin 500-1000 mg PO tid OR Amoxicillin/Clavulanate 875/125 mg PO bd.

• (3)Middle ear (otitis media)

• (4)Bronchi (acute exacerbation of chronic bronchitis)

• Preferred regimen: amoxicillin 2-3 PO g/day OR Doxycycline 100 mg PO bd.

• (5)CNS (meningitis)

• Empiric therapy

• Preferred regimen: Vancomycin 15 mg/kg/day IV q12h AND Ceftriaxone 2 g IV q12h OR Cefotaxime 2 g IV q4h or 3 g q6h.

• Penicillin sensitive (minimum inhibitory concentration ≤ 0.06)

• Preferred regimen: Ceftriaxone 2 g IV q12h, OR Cefotaxime 2 g IV q4h or 3 g IV q6h.

• Penicillin resistant (minimum inhibitory concentration ≥ 0.12) or beta-lactam hypersensitivity

• Preferred regimen: Vancomycin 30-45 mg/kg/day IV.

Dexamethasone 0.15 mg/kg IV q6h for 2-4 days starting 10-20 min before antibiotic.

• (6)Peritoneum (spontaneous bacterial peritonitis)

• (7)Pericardium (purulent pericarditis)

• (8)Skin (cellulitis)

• (9)Eye (conjunctivitis)

• 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.

Case Studies

Case #1

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