Which antibiotic regimens are used in the treatment of pediatric pneumococcal infections?

Updated: Jan 14, 2019
  • Author: Meera Varman, MD; Chief Editor: Russell W Steele, MD  more...
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Answer

Antibiotic therapy and supportive care are indicated. The key to successful antibiotic therapy is achieving drug concentrations in the affected area of the body that are several times higher than the minimal inhibitory concentration (MIC) for S pneumoniae.

Recommendations for particular clinical situations include the following:

  • OM or sinusitis (initial treatment) – Amoxicillin for 5-10 days (otitis media) or 10-21 days (sinusitis)

  • OM or sinusitis that does not improve with standard-dose amoxicillin – High-dose amoxicillin, amoxicillin-clavulanate, cefuroxime, or ceftriaxone (IM)

  • Pneumonia (outpatient) – Amoxicillin for 10 days

  • Pneumonia (inpatient) – IV ceftriaxone until clinical improvement, then 10 days of outpatient treatment; in critical illness, addition of vancomycin should be considered

  • Other invasive pneumococcal diseases – A third- or fourth-generation parenteral cephalosporin (ceftriaxone, cefotaxime, cefepime); in critical illness or the absence of clinical improvement, addition of vancomycin should be considered

  • Meningitis – Ceftriaxone or cefotaxime; meropenem may be an alternative in cases of ceftriaxone resistance; vancomycin is always added until susceptibilities are known; rifampin may be added after 24-48 hours of improvement is not noted or the relevant MIC is high

  • Penicillin allergy (OM, sinusitis, outpatient treatment of pneumonia) – Azithromycin (or other macrolide), clindamycin, cefuroxime (if there is no cephalosporin allergy), or cefprozil

  • Penicillin allergy (inpatient treatment of pneumonia or other invasive infections) – IV ceftriaxone (if there is no cephalosporin allergy); alternatively, IV clindamycin or meropenem; vancomycin may be considered if the patient is severely ill and microbial susceptibility is unknown

See Treatment and Medication for more detail.


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