Streptococcus pneumoniae (pneumococcal) bacteraemia

Australian Commission on Safety and Quality in Health Care (ACSQHC), 2023

The following regimens apply to adults and children with Streptococcus pneumoniae (pneumococcal) bacteraemia not associated with meningitis, or sepsis or septic shock. For adults and children with meningitis, or sepsis or septic shock, see Approach to managing Streptococcus pneumoniae (pneumococcal) bloodstream infections.

In adults and children with pneumococcal bacteraemia not associated with meningitis, or sepsis or septic shock, use:

benzylpenicillin 2.4 g (child: 60 mg/kg up to 2.4 g) intravenously, 6-hourly. For dosage adjustment in adults with kidney impairment, see benzylpenicillin dosage adjustment. See advice on duration of therapy. benzylpenicillin benzylpenicillin benzylpenicillin

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

1ceftriaxone 2 g (child 1 month or older: 50 mg/kg up to 2 g) intravenously, daily. See advice on duration of therapy ceftriaxone ceftriaxone ceftriaxone

OR

1cefotaxime 2 g (child: 50 mg/kg up to 2 g) intravenously, 8-hourly. For dosage adjustment in adults with kidney impairment, see cefotaxime dosage adjustment. See advice on duration of therapy. cefotaxime cefotaxime cefotaxime

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

1moxifloxacin 400 mg (child: 10 mg/kg up to 400 mg) intravenously, daily3. For dosage adjustment in adults with kidney impairment, see moxifloxacin dosage adjustment. See advice on duration of therapy moxifloxacin moxifloxacin moxifloxacin

OR

1vancomycin intravenously; for initial dosing, see Vancomycin dosing in adults or Intermittent vancomycin dosing for young infants and children. Loading doses are recommended for critically ill adults. See advice on duration of therapy. vancomycin vancomycin vancomycin

Oral moxifloxacin may be a suitable alternative to intravenous moxifloxacin if the patient can tolerate oral therapy.

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
3 Moxifloxacin is not licensed for use in children on the basis of animal studies that showed an adverse effect on cartilage development with quinolone use; however, clinical trial data suggest that adverse musculoskeletal events are usually mild and short term, similar to those observed in adults. Moxifloxacin can be used in children when it is the drug of choice.Return