Duration of therapy for Streptococcus pneumoniae (pneumococcal) pneumonia
McMullan, 2016Metlay, 2019Uranga, 2016
For Streptococcus pneumoniae (pneumococcal) pneumonia, there is increasing evidence that shorter durations of therapy are as effective as longer durationsBielicki, 2021Dinh, 2021Ginsburg, 2020McCallum, 2022Pernica, 2021Williams, 2022. The total duration of therapy (intravenous + oral) usually ranges from 3 to 7 days. More than 7 days of therapy may be needed in specific circumstances.
Consider the following factors when deciding the duration of therapy:
- concomitant bacteraemia – treat for 7 days. Patients with persistent bacteraemia may require longer than 7 days of therapy; seek expert advice
- pneumonia severity1 and response to therapy – patients who are still unwell after 3 days may require a longer course of treatment
- clinical evidence of deep collections (eg empyema) – a duration longer than 7 days is required for patients with lung abscess, or complicated parapneumonic effusion or empyema.
For management of patients who are not improving, see (as relevant):
- Approach to managing adults with CAP who are not improving
- Approach to managing children 2 months or older with CAP who are not improving
- Approach to managing patients with HAP who are not improving
- Approach to managing patients with VAP who are not improving.
General strategies to prevent further episodes of pneumonia in adults are outlined in Prevention of CAP in adults. For strategies to prevent hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP), see Prevention of HAP or Prevention of VAP.