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Treatment of pneumococcal pneumonia

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Pneumococcal pneumonia is generally treated with amoxycillin, doxycycline or clarithromycin. (1)

For severe infections:

  • intravenous antibiotics e.g. amoxicillin, doxycycline. Oral treatment can be used when the pneumonia is resolving clinically and the patient is apyrexial.

For mild-moderate infections:

  • amoxicillin 500mg-1g tds for 10-14 days* PO (1)
    • in patients allergic to penicillin, a suitable alternative is erythromycin 500mg qds PO or clarithromycin 500mg bd** PO (1)

Alternative treatments in penicillin allergy include erythromycin or cefuroxime (but note 10% cross-sensitivity).


  • pneumococcal vaccination


  • *BTS guidelines recommend adequate dosing of amoxicillin to cover intermediate-resistant strains of Strep pneumoniae
  • ** clarithromycin may be substituted for those with gastrointestinal intolerance to oral erythromycin and also has benefit of twice daily dosage


Pneumonia (community-acquired): antimicrobial prescribing. NICE guideline [NG138]Published: 16 September 2019

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