Intravenous 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 S. pneumoniae 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.

For patients with more severe S. pneumoniae pneumonia (eg patients with bacteraemia), use:

benzylpenicillin intravenously 2.4 g (child: 60 mg/kg up to 2.4 g) 6-hourly. For dosage adjustment in adults with kidney impairment, see benzylpenicillin dosage adjustment. See below for intravenous to oral switch. benzylpenicillin benzylpenicillin benzylpenicillin

For patients with S. pneumoniae pneumonia who are unable to tolerate or absorb oral (or enteral) therapy but do not have more severe pneumonia, use:

benzylpenicillin intravenously 1.2 g (child: 50 mg/kg up to 1.2 g) 6-hourly. For dosage adjustment in adults with kidney impairment, see benzylpenicillin dosage adjustment. See below for intravenous to oral switch.benzylpenicillin benzylpenicillin benzylpenicillin

For patients 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 below for intravenous to oral switch ceftriaxone ceftriaxone ceftriaxone

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 below for intravenous to oral switch. cefotaxime cefotaxime cefotaxime

For patients who have had 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 below for intravenous to oral switch moxifloxacin moxifloxacin moxifloxacin

2vancomycin intravenously; for initial dosing, see Intermittent vancomycin dosing for noncritically ill adults or Intermittent vancomycin dosing for young infants and children. See below for intravenous to oral switch. vancomycin vancomycin vancomycin

Intravenous to oral switch: once the patient improves, switch to oral therapy (for guidance on when to switch to oral therapy, see Guidance for intravenous to oral switch):

For patients without penicillin hypersensitivity, use amoxicillin.
For patients with nonsevere (immediate or delayed) penicillin hypersensitivity, or severe immediate¹ penicillin hypersensitivity who tolerated ceftriaxone or cefotaxime, use cefuroxime.
For patients with severe immediate¹ penicillin hypersensitivity in whom ceftriaxone or cefotaxime was not used nor tolerated, or for patients with severe delayed² penicillin hypersensitivity, use doxycycline.

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