Intravenous therapy for S. pneumoniae (pneumococcal) bronchiectasis exacerbations in adults

For adults with a bronchiectasis exacerbation who require intravenous therapy, if S. pneumoniae is isolated in the sputum sample, useChang, 2023:

benzylpenicillin 1.2 g intravenously, 6-hourly; see advice on modification and duration of therapy. For dosage adjustment in adults with kidney impairment, see benzylpenicillin dosage adjustment. benzylpenicillin benzylpenicillin benzylpenicillin

At the dosage recommended above, benzylpenicillin remains active against strains of S. pneumoniae with dose-dependent susceptibility to penicillin (ie susceptible dose dependent [SDD] or susceptible increased exposure [I or SIE]) for most infections without CNS involvement, including bronchiectasis. For exacerbations that have not improved with the dosage recommended above or if the minimum inhibitory concentration (MIC) is 1 to 4 mg/L, consider using the benzylpenicillin dose for S. pneumoniae (pneumococcal) pneumonia. For S. pneumoniae strains with high-level penicillin resistance (MIC 4 mg/L or higher), seek expert advice from a clinical microbiologist or infectious diseases physician.

For adults who have had a nonsevere (immediate or delayed) or a severe immediate1 hypersensitivity reaction to a penicillin, use:

ceftriaxone 2 g intravenously, daily; see advice on modification and duration of therapy. ceftriaxone ceftriaxone ceftriaxone

For adults who have had a severe delayed2 hypersensitivity reaction to a penicillin, use:

moxifloxacin 400 mg intravenously, daily; see advice on modification and duration of therapy. For dosage adjustment in adults with kidney impairment, see moxifloxacin dosage adjustment. moxifloxacin moxifloxacin moxifloxacin

1 Severe immediate hypersensitivity reactions include anaphylaxis, compromised airway, airway angioedema, hypotension and collapse.Return
2 Severe delayed hypersensitivity reactions include cutaneous adverse drug reactions (eg drug rash with eosinophilia and systemic symptoms [DRESS], Stevens–Johnson syndrome/toxic epidermal necrolysis [SJS/TEN], severe blistering or desquamative rash), and significant internal organ involvement (eg acute interstitial nephritis).Return