Streptococcus pneumoniae prophylaxis in immunocompromised adults without HIV infection

This section includes regimens for antibiotic prophylaxis against Streptococcus pneumoniae in immunocompromised adults without HIV infection. To assess if S. pneumoniae prophylaxis is indicated, see Assessing the need for antimicrobial prophylaxis in immunocompromised adults without HIV infection.

For S pneumoniae prophylaxis in patients with asplenia or hyposplenism, see Prevention of infection in asplenic and hyposplenic patients.

For S. pneumoniae prophylaxis in immunocompromised adults without HIV infection, use:

Penicillins are the drugs of choice for antibiotic prophylaxis of S. pneumoniae. Penicillin resistance in S. pneumoniae is low and rates of resistance to alternative antibiotics are much higher.

For patients who report penicillin hypersensitivity, verify their allergy. In some patients it may be appropriate to directly delabel their allergy by taking an extensive allergy history (see Clinical history for initial assessment of patients reporting penicillin hypersensitivity). In patients whose penicillin allergy has been delabeled, amoxicillin should be used.

Seek expert advice for patients with a verified allergy to guide antibiotic choice. For patients who have had a nonsevere (immediate or delayed) or a severe immediate hypersensitivity reaction to a penicillin¹, an infectious diseases physician or clinical microbiologist may also perform desensitisation.

For S. pneumoniae immunisation recommendations, see the Australian Immunisation Handbook [URL].