Approach to managing Streptococcus pneumoniae (pneumococcal) pneumonia
Report cases of invasive pneumococcal disease to the local public health authority. For case definitions and other public health advice, see the public health advice for Pneumococcal disease – invasive. For contact details for Australian state and territory government health departments and public health units, see here.
Consider testing patients with recurrent pneumococcal infections for an immune system disorder (eg human immunodeficiency virus [HIV]).
A penicillin is the drug of choice for Streptococcus pneumoniae pneumonia. At the dosages recommended in this topic, benzylpenicillin and amoxicillin remain 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 central nervous system (CNS) involvement, including pneumonia. For S. pneumoniae strains with high-level penicillin resistance (minimum inhibitory concentration [MIC] 4 mg/L or higher), seek expert advice from a clinical microbiologist or infectious diseases physician.
Oral therapy is recommended whenever possible. Use intravenous therapy for patients with more severe pneumococcal pneumonia (eg patients with bacteraemia), or patients who are unable to tolerate or absorb oral (or enteral) therapy. If the patient has S. pneumoniae bacteraemia with signs of sepsis or septic shock, use the antibiotic regimens for Streptococcus pneumoniae (pneumococcal) sepsis or septic shock.