Approach to managing Streptococcus pneumoniae (pneumococcal) bloodstream infections

Benzylpenicillin is the drug of choice for Streptococcus pneumoniae (pneumococcal) bacteraemia, and sepsis and septic shock not associated with meningitis. At the dosages recommended in this topic, benzylpenicillin is active against strains of S. pneumoniae with intermediate susceptibility to penicillin (minimum inhibitory concentration [MIC] less than 4 mg/L). At the time of writing, S. pneumoniae strains with high-level penicillin resistance are uncommon in Australia.

Recommendations are included in these guidelines for adults and children with S. pneumoniae bloodstream infection that is:

• associated with meningitis
  • results of susceptibility testing are not available – see Meningitis in adults and children 2 months or older or Meningitis in neonates and children younger than 2 months
  • results of susceptibility testing are available – see Streptococcus pneumoniae (pneumococcal) meningitis
• not associated with meningitis
  • sepsis or septic shock
  • bacteraemia.

Report cases of S. pneumoniae bloodstream infection to the local public health authority¹. For case definitions and other public health advice, see the public health advice for Pneumococcal disease – invasive.