TAILIEUCHUNG - Chapter 128. Pneumococcal Infections (Part 9)

Inpatient Therapy Pneumococcal pneumonia is readily treatable with β-lactam antibiotics. The conventional dosages shown in Table 128-5 are acceptable against intermediately resistant strains and against many or most fully resistant isolates. Recommended agents include ceftriaxone and cefotaxime. Ampicillin is also widely used, usually in the form of ampicillin/sulbactam. The likely efficacy of newer quinolones such as moxifloxacin, macrolides such as azithromycin, and clindamycin is discussed above. On the basis of in vitro considerations, vancomycin is likely to be uniformly effective against pneumococci; this drug or a quinolone should be used together with a third-generation cephalosporin for initial therapy in. | Chapter 128. Pneumococcal Infections Part 9 Inpatient Therapy Pneumococcal pneumonia is readily treatable with 0-lactam antibiotics. The conventional dosages shown in Table 128-5 are acceptable against intermediately resistant strains and against many or most fully resistant isolates. Recommended agents include ceftriaxone and cefotaxime. Ampicillin is also widely used usually in the form of ampicillin sulbactam. The likely efficacy of newer quinolones such as moxifloxacin macrolides such as azithromycin and clindamycin is discussed above. On the basis of in vitro considerations vancomycin is likely to be uniformly effective against pneumococci this drug or a quinolone should be used together with a third-generation cephalosporin for initial therapy in a patient who is likely to be infected with a highly antibiotic-resistant strain. Patients who have had a severe allergic reaction to penicillins or cephalosporins may be treated with a carbapenem . imipenem-cilastatin a quinolone or vancomycin. The failure of a patient to respond promptly should at least prompt consideration of drug resistance. Evidence for loculated infections such as empyema and or other causes of fever should be sought and addressed appropriately. Duration of Therapy The optimal duration of treatment for pneumococcal pneumonia is uncertain. Pneumococci begin to disappear from the sputum within several hours after the first dose of an effective antibiotic and a single dose of procaine penicillin which produces an effective antimicrobial level for 24 h was curative in otherwise-healthy young adults in an era when all isolates were susceptible. Early in the antibiotic era most physicians treated pneumococcal pneumonia for 5-7 days. In the absence of data suggesting a need for longer treatment younger physicians tend to treat the infection for 10-14 days. In the opinion of this author a few days of close observation and parenteral therapy followed by an oral antibiotic with the entire course of .

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