infectious diseases
Pneumococcal Infections
Key Points
Streptococcus pneumoniae(pneumococci) bacteria are gram-positive, alpha-hemolytic, aerobic, encapsulated diplococci. Pneumococci cause many cases of otitis media and pneumonia and can also cause meningitis, sinusitis, endocarditis, and septic arthritis. Patients with chronic respiratory tract disease or asplenia are at high risk of serious and invasive pneumococcal infections, as are patients who are immunocompromised. Treat uncomplicated or mild infection with a beta-lactam or macrolide antibiotic. Because resistance to beta-lactam and macrolide antibiotics is increasing, seriously ill patients may be treated with an advanced-generation cephalosporin (eg,ceftriaxoneorcefotaxime) based on minimal inhibitory concentration (MIC); other options include a respiratory fluoroquinolone (eg,moxifloxacin,levofloxacin), atetracycline(eg,omadacycline), or a pleuromutilin (eg,lefamulin). Severe or bacteremic pneumococcal pneumonia is treated with combination therapy (eg, a macrolide plus a beta-lactam). Prevent pneumococcal infection in children 2 months through 6 years of age by giving pneumococcal vaccination as part of a Childhood Vaccination Schedules . Prevent pneumococcal infection in adults by giving additional pneumococcal vaccination at age 19 to 64 years for those who have certain chronic medical conditions or other risk factors and at age > 65 years for all other adults. 