What is the treatment for streptococcus pneumoniae
Diagnosis and Treatment
Sep 06, · Antibiotic treatment for serious pneumococcal infections typically includes ‘broad-spectrum’ antibiotics until results of antibiotic sensitivity testing are available. Antibiotic sensitivity testing shows which antibiotics will be most successful at treating a bacterial infection. Broad-spectrum antibiotics work against a wide range of bacteria. What is the treatment for S. pneumoniae infection? The main treatment for invasive S. pneumoniae infection is antibiotics. What can be done to prevent the spread of S. pneumoniae?
Penicillin-susceptible and intermediately resistant pneumococci are likely to respond better to this treatment than to any other. Because of the high rate of spontaneous resolution, the American Academy of Pediatrics has subsequently recommended watchful waiting for children aged greater than 2 years unless severe pain or high fever are present, and these recommendations seem appropriate for adults, as well.
When adults are treated, amoxicillin should be given at mg four times daily. In the absence of a perforated tympanic membrane or some other complication, therapy need not be continued beyond 5 days. Because of similarities in pathogenesis and causative organisms, the same considerations apply to the treatment of acute sinusitis.
Treatment should be given for 5 days; numerous studies and meta-analyses have shown no benefit from more prolonged therapy. Unlike children, for whom quinolones have not been approved, adults can be treated with this class of drugs.
Ceftriaxone is the fall-back choice, and failure after this antibiotic has been tried is likely to require referral to an otolaryngologist. To treat outpatients for pneumonia, the Infectious Diseases Society of America recommends, in no particular order, a macrolide, doxycycline, amoxicillin with or without clavulanic acidor a quinolone. There is no certainty of cure in infectious diseases practice, and, in the opinion of the present writer, the cautious physician would do well to try to make the correct diagnosis by microbiologic means.
Treatment is initially begun in most cases without a diagnosis being known. Macrolides, tetracyclines, and quinolones are effective against mycoplasmas and Chlamydophila that are more likely to cause outpatient than inpatient pneumonia. The relatively high rate of resistance of pneumococci to macrolides or doxycycline seems to favor the use of a quinolone. In Sweden, the recommended drug for outpatient treatment of pneumonia is penicillin. The importance of the decision to hospitalize or even to directly admit to intensive care cannot be overemphasized, and Pneumonia Patient Outcomes Research How to rattle can paint a car PORT scoring should be used to help decide whether hospitalization is needed.
Pneumococcal pneumonia caused by organisms that are susceptible or intermediately resistant to penicillin responds to treatment with penicillin, one million units intravenously what foods have the most fiber 4 hours, ampicillin, 1g every 6 hours, or ceftriaxone, 1g every 24 hours.
Ease of administration favors the use of ceftriaxone. The principal problem is that at the time treatment is begun, the etiology is likely not to be known. If a Gram stain of sputum at admission shows pneumococci, ceftriaxone is the preferred drug, unless the patient is extremely ill, in which case vancomycin should be added until the susceptibility of the infecting organism is known.
Patients who are treated for pneumococcal pneumonia with an effective antibiotic generally have substantially reduced fever and feel much better within 48 hours. Based on all the foregoing considerations, if a patient has responded to treatment with a how to succeed with online dating antibiotic, this therapy should be continued even if the antibiotic-susceptibility test labels the causative organism as resistant.
If, however, a clear response is not observed and the organism is resistant, therapy should be changed in accordance with susceptibility testing results.
The optimal duration of therapy for pneumococcal pneumonia is uncertain. Pneumococci are not readily detected in sputum microscopically by culture more than 24 hours after the administration of an effective antibiotic.
Experience obtained early in the antibiotic era showed that 5 to 7 days of therapy sufficed, and a small-scale study in the s showed that a single dose of procaine penicillin, which maintains an effective antimicrobial level for as long as 24 hours, could cure otherwise healthy young adults of pneumococcal pneumonia. Nevertheless, the tendency of the medical profession has been to prolong therapy and, in the absence of data to prove additional benefit, most physicians now treat pneumonia for 10 to 14 days.
The overall duration of therapy should not exceed 10 days. Pneumococcal meningitis has been treated with 12 to 24 million units of penicillin every 24 hours, 2g ceftriaxone every 12 hours or 2mg cefotaxime every 6 hours.
Any of these regimens are effective against antibiotic-susceptible S. During treatment of resistant strains, beta-lactam antibiotics are likely not to achieve therapeutic levels in CSF.
This explains why, until susceptibility results are reported, vancomycin is recommended along with a beta-lactam. Unless the history suggests a life-threatening reaction to a beta-lactam, ceftriaxone or cefotaxime are preferred.
In treating pneumococcal meningitis, addition of dexamethasone, 10mg four times daily, leads to a distinctly better outcome. Because of the possibility that steroids may diminish the penetration of antibiotics into the central nervous system CNSpatients receiving these agents should be observed particularly closely; repeat spinal taps may be needed to document abatement what is the best brand of snowboard goggles CSF abnormalities, particularly if there is any suggestion of a delayed clinical response.
In any case, steroid administration what is the treatment for streptococcus pneumoniae not be continued beyond the recommended 4 days. Initial therapy should include vancomycin and ceftriaxone until the results of minimal bactericidal concentration testing are known. An aminoglycoside may inhibit the bactericidal activity of beta-lactam antibiotics and should not be added unless synergy in vitro is documented to occur. Corticosteroids, statins, and macrolides all exhibit a variety of anti-inflammatory effects.
The use of steroids in treating meningitis has been discussed earlier in this chapter. Randomized prospective studies have, in fact, shown no benefit from the addition of corticosteroids in treating pneumonia, but a large prospective study is currently underway within the US Veterans Affairs health care system. Patients who are already on treatment with a statin at the time of admission for pneumococcal pneumonia have better outcomes than those who are not; a prospective study in which patients are randomized to receive a statin has not been reported.
Several case control studies have compared outcomes in patients receiving a macrolide and a beta-lactam with those in patients receiving a macrolide what is the time and date. Results have favored the former group but, once again, a prospective study has not been done.
The subject of pneumococcal resistance to antibiotics is complicated because definitions have changed and susceptibility patterns have evolved, but these definitions will dictate good clinical practice, and clinicians need to understand them. Inafter two decades of increasing emphasis on the prevalence of penicillin-resistant pneumococci, the definitions of susceptibility were changed to reflect the site of infection and the route of therapy.
If oral penicillin is to be used for therapy, the old definitions apply, such that organisms with MIC less than 0. Similar approaches have been developed to define susceptibility to amoxicillin, ceftriaxone, and other beta-lactam antibiotics.
Pneumococci with low MICs for penicillin remain susceptible to most other antibiotics, whereas strains that have reduced susceptibility what is the treatment for streptococcus pneumoniae penicillin tend to be multiply resistant. At present, in the United States:. The numbers of organisms present in the nasopharynx of infants and young children is much greater than in adults, a fact that explains the high false-positive rate for the pneumococcal urine antigen test and its lack of utility in those populations see later in this chapter, laboratory diagnosis.
In adults, close, crowded living conditions such as occur in military camps, prisons, shelters for the homeless, and nursing homes are associated with epidemics, but contact in schools or in the workplace is generally not. In infants and young children, otitis media follows acquisition of a new colonizing strain.
After a few weeks, protection reflects the presence of antibody. An important clinical corollary of this observation is that persons who are not able to mount antibody responses remain susceptible to pneumococcal disease as long as they remain colonized see later in this chapter, predisposing factors.
Before the widespread use of conjugate pneumococcal vaccine see later in this chapter, prevention in infants and toddlers, the incidence of invasive pneumococcal disease was:. In the past few years, thanks to that vaccine, the incidence in these groups is 25, 8, and 60, respectively.
In certain populations, including African-Americans, Native Americans particularly Alaskans and certain aboriginal populations, the incidence may be up to fold greater, although it is unclear to what extent genetic or environmental factors are responsible. Since several steps intervene between exposure to an organism, colonization, and development of infection, direct contagion is not generally an issue. Spread of pneumococcal infection within a hospital environment is exceedingly rare.
There are no recommendations beyond universal precautions. The capsular polysaccharides are each bound chemically to a nontoxigenic protein that closely resembles diphtheria toxin. The problem with pneumococcal vaccination is that those who are in greatest need of it are least likely to generate good antibody responses. Older persons and those who have chronic lung or heart disease have lower antibody levels after vaccination, and their immunoglobulin Ig G is less active in functional assays in vitro.
Persons who have immunosuppressive conditions that place them at highest risk of pneumococcal infection, such as multiple myeloma, Hodgkin disease, splenectomy, lymphoma, nephrotic syndrome, renal failure, cirrhosis, how to calculate work done by friction cell disease, bone marrow transplantation, and human immunodeficiency virus HIV infection respond poorly, if at all, to polysaccharide antigens.
Persons who have recovered from pneumococcal pneumonia respond initially to vaccination, but no longer have detectable levantibody at 6 months. General categories included within these recommendations are those persons who:. Recommendations regarding revaccination seem to be somewhat inconsistent because the committee advocates a single revaccination in persons over the age of 65 years as well as most others.
Since antibody levels decline and there is no anamnestic how to create a taco bar, it seems more reasonable simply to recommend:. Revaccination at 5 to 7 year intervals, particularly in adults over the age of 65 years, who will have a minimal local reaction.
Hyporesponsiveness the failure to make antibody to a second vaccination when given soon after a first vaccination is not seen 5 years after prior vaccination. Revaccination every 5 years for persons who are at highest risk of recurring pneumococcal infection—those who have undergone splenectomy or have a CSF leak. Infants and young children do not make antibody after vaccination with pure polysaccharide antigens.
However, when pneumococcal capsular polysaccharides have been covalently conjugated to carrier proteins, the resulting antigens are recognized as T-cell dependent; they stimulate good antibody responses in children under the age of 2 years and induce immunologic memory.
An untoward result of widespread vaccination has been the appearance of new strains that are not contained in the vaccine; these are called replacement strains. The principal one, type 19A, has become the predominant cause of pneumococcal disease in all age groups in the United States. This serotype is included in PCV13 which was put into widespread use in Hopes that protein conjugation would greatly enhance antibody responses have not been fulfilled.
A comparison of antibody levels and opsonic effect after vaccination with PPV23 versus PCV showed remarkably few differences or modestly higher antibody levels after PCV. The lack of convincing differences in responses to the two vaccine preparations and the fact that widespread use of PCV13 in children is expected to be followed by disappearance from the population of vaccine strains suggests to some authorities that routine vaccination of adults how to replace lost sim card PCV13 in the United States will be of little benefit.
Protein vaccines. Vaccines utilizing conserved protein antigens might bypass the problems relating to polysaccharide vaccines. Pneumolysin is a major virulence factor of S. Antibody is protective in such animals.
A pneumolysoid vaccine is currently in development. Antibody to certain surface expressed proteins such as PspA pneumococcal surface protein A or the Pht pneumococcal histidine triad proteins has been shown to be protective in experimental animals, and these are also under study as vaccine candidates. The principal defense against infection is ingestion by dendritic and phagocytic cells; in the absence of antibody, it resists phagocytosis and replicates extracellularly in mammalian tissues.
The polysaccharide capsule is chiefly responsible for resistance to ingestion and killing by host phagocytic cells. Except for strains that cause conjunctivitis, nearly all pneumococci that cause disease in humans are encapsulated. A total of 91 different pneumococcal capsular polysaccharides have been recognized; these form the basis for the common identification system. It is important to the clinician to be familiar with the concept of capsular types because of their importance in new formulations of pneumococcal vaccine see later in this chapter.
Antibody to capsule is the principal defense mechanism against infection due to pneumococcus, but antibody to pneumolysin the only recognized important toxin of S. Once nasopharyngeal colonization has taken place, infection may result if the organisms are carried into cavities from which they are not readily cleared.
Under normal circumstances, when bacteria find their way into the Eustachian tubes, sinuses, or bronchi, clearance mechanisms, chiefly ciliary action, lead to their rapid removal. If conditions such as coexisting viral infection, exposure to pollutants, or an allergic condition cause edema that obstructs the opening of the Eustachian tube into the pharynx or the ostium of a paranasal sinus, clinically recognizable infection may result.
Similarly, glottal and cough reflexes and ciliary activity of bronchial epithelial cells prevent pneumococci from infecting the lower airways. Damage to ciliated bronchial cells or increased production of mucus, whether chronic for example, from cigarette smoking or occupational exposure or acute from influenza or some other viral infectionmay prevent the clearance of inhaled or aspirated organisms, predisposing the patient to infection.
Respiratory viral infection, especially that due to influenza virus, plays a prominent role in predisposing the patient to pneumococcal pneumonia. Upregulation of surface receptors during viral infection may enhance pneumococcal adherence and invasion.
Bacteria are certainly less well cleared from the airways because of viral-induced damage.
Sep 06, · Streptococcus pneumoniae are lancet-shaped, gram-positive, facultative anaerobic bacteria with known likedatingall.com S. pneumoniae serotypes can cause disease, but only a minority of serotypes produce the majority of pneumococcal infections.. Pneumococci are common inhabitants of the respiratory tract. The bacteria may be isolated from the nasopharynx of 5–90% of . Jan 20, · When adults are treated, amoxicillin should be given at mg four times daily. If this treatment fails, amoxicillin/clavulanic acid, a fluoroquinolone or ceftriaxone can be used. In the absence of a perforated tympanic membrane or some other complication, therapy . What is the treatment for S. pneumoniae infection? The main treatment for invasive S. pneumoniae infection is antibiotics. What can be done to prevent the spread of S. pneumoniae? Vaccines can help to prevent invasive S. pneumoniae infections. Pneumococcal conjugate vaccine valent (PCV) is recommended for all children starting at two months up to 59 months of age.
Streptococcus pneumoniae are bacteria that are commonly found in the nose and throat of children and adults. Many people carry S. Unvaccinated children, the elderly, and other people with weakened immune systems are the most at risk for invasive infection, but some people get an invasive infection for no apparent reason.
The bacteria are spread from person to person by the breathing in droplets produced by an infected person during coughing or sneezing. Signs and symptoms depend on the part of the body affected. Invasive infection often includes fever, chills, and irritability. Headache, stiff neck, confusion, sleepiness, vomiting, and poor feeding can occur with meningitis. The incubation period varies. Signs and symptoms of infection can occur within days after exposure, but may occur long after exposure.
Laboratory tests on blood, pleural fluid, joint fluid, or cerebrospinal fluid CSF are needed to confirm the diagnosis of invasive disease. Vaccines can help to prevent invasive S. Pneumococcal conjugate vaccine valent PCV is recommended for all children starting at two months up to 59 months of age. Pneumococcal polysaccharide vaccine valent PPSV is used in high-risk individuals two years of age or older.
Consult with your doctor or local health department to determine if the vaccine is recommended for you. Frequent handwashing with soap and water or, when soap and water are not available, the use of alcohol-based hand rubs or gels can help stop the spread of many viruses and bacteria. Not sharing food, drinks, or eating utensils with other people can also help to stop the spread of germs.
Preventive treatment e. The contagious period varies and may last for as long as the organism is present in the nose and throat.
A person can no longer spread S. Check restaurant inspections? Apply for WIC? Get Help to Quit Smoking? Check out home health service providers? Report a foodborne illness? File a complaint about a health care facility? Need vaccine? Learn how to get your shot at Vaccinate. Language translation available, TTY users dial Usuarios de TTY pueden marcar al
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