How are specific pneumococcal infections treated?

Updated: Jun 08, 2020
  • Author: Eduardo Sanchez, MD; Chief Editor: John L Brusch, MD, FACP  more...
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Antibiotics are the mainstay of therapy. Treatments for specific infections may include the following:

  • Otitis media: In most cases, amoxicillin 80-90 mg/kg/day; if there is no improvement within 48-72 hours, amoxicillin-clavulanate or a second- or third-generation oral cephalosporin (or parenteral ceftriaxone for highly resistant pneumococci)
  • Sinusitis: Initial recommendations as for otitis media; in adult penicillin-allergic patients and patients who do not respond to initial therapy, switching to fluoroquinolones (not approved for children in this clinical situation) may be considered
  • Pneumonia: For penicillin-sensitive S pneumoniae (minimum inhibitory concentration [MIC] < 2 μg/mL), penicillin G or amoxicillin is considered first-line therapy; for penicillin-resistant S pneumoniae infection (MIC ≥2 μg/mL), the choice of antimicrobial agent should be directed by susceptibility testing [3]
  • Meningitis: In children, a beta-lactam (penicillin, ceftriaxone, or cefotaxime) with or without vancomycin pending susceptibility testing; children with hypersensitivity to beta-lactams should receive vancomycin plus rifampin; meropenem and chloramphenicol have also been used; for adults with penicillin-sensitive S pneumoniae infection (MIC ≤ 0.06 μg/mL), intravenous penicillin G or ampicillin is first-line therapy; for penicillin-resistant pneumococcus (MIC ≥0.12 μg/mL), treatment with a third-generation cephalosporin (if ceftriaxone or cefotaxime MIC < 1 μg/mL) or a third-generation cephalosporin plus vancomycin (if cefotaxime or ceftriaxone MIC ≥1 μg/mL) is recommended

Additional treatment measures that may be helpful for particular conditions are as follows:

  • Complicated pneumonia: Chest tube placement for drainage of pleural fluid; in more severe cases, VATS or decortication
  • Suspected septic arthritis or osteomyelitis: Collection of appropriate specimens for Gram stain, cell count, histology, or culture
  • Recurrent or chronic otitis media, periorbital or orbital cellulitis, or facial cellulitis: Surgical intervention

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