Treatment of pneumococcal pneumonia

Pneumococcal pneumonia is generally treated with amoxycillin, ampicillin or co-amoxiclav.

For severe infections:

• intravenous antibiotics e.g. ampicillin or co-amoxiclav. Oral amoxicillin or augmentin 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).

Prophylaxis:

• pneumococcal vaccination

Notes:

• *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

Reference:

1. Thorax 2001;56 (suppl IV).
2. Drugs and Therapeutics Bulletin (1998), 36 (9), 65-72.