Oral therapy for Streptococcus pneumoniae (pneumococcal) pneumonia

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

Oral therapy is recommended whenever possible for Streptococcus pneumoniae (pneumococcal) pneumonia. Use intravenous therapy for patients with more severe pneumococcal pneumonia (eg patients with bacteraemia).

For S. pneumoniae pneumonia in adults and children who can tolerate and absorb oral (or enteral) therapy, use:

amoxicillin 1 g (child: 25 mg/kg up to 1 g) orally or enterally, 8-hourly. For dosage adjustment in adults with kidney impairment, see amoxicillin dosage adjustment. See advice on duration of therapy. amoxicillin amoxicillin amoxicillin

For patients who have had a nonsevere (immediate or delayed) hypersensitivity reaction to a penicillin1, use:

cefuroxime 500 mg (child 3 months or older: 15 mg/kg up to 500 mg) orally or enterally, 12-hourly. For dosage adjustment in adults with kidney impairment, see cefuroxime dosage adjustment. See advice on duration of therapy. cefuroxime cefuroxime cefuroxime

For children in whom a suitable formulation of cefuroxime is not available, or for patients who have had a severe (immediate or delayed)2 hypersensitivity reaction to a penicillin, use the results of susceptibility testing to guide therapy. While awaiting results, use:

doxycycline orally or enterally, 12-hourly3; see advice on duration of therapy doxycycline doxycycline doxycycline

adult: 100 mg

child less than 21 kg: 2.2 mg/kg4

child 21 to less than 26 kg: 50 mg

child 26 to 35 kg: 75 mg

child more than 35 kg: 100 mg.

If doxycycline cannot be used, other options are azithromycin, clarithromycin or moxifloxacin.

Modify therapy when susceptibility results are available.

1 For patients with severe immediate penicillin hypersensitivity who tolerated initial intravenous therapy with ceftriaxone or cefotaxime, it is safe to use cefuroxime.Return
2 Severe immediate hypersensitivity reactions include anaphylaxis, compromised airway, airway angioedema, hypotension and collapse. 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 An oral liquid formulation of doxycycline is not marketed in Australia but is available via the Special Access Scheme. For formulation options for children or people with swallowing difficulties, see Don’t Rush to Crush, which is available for purchase from the Advanced Pharmacy Australia website or through a subscription to eMIMSplus.Return
4 When used short term (eg less than 21 days), doxycycline has not been associated with tooth discolouration, enamel hypoplasia or bone deposition so can be used in children of all ages.Return