Treatment of pneumococcal pneumonia

The emergence of Streptococcus pneumoniae strains with resistance to penicillin, macrolide, and other drugs has made the treatment of pneumococcal infections more complicated. Although resistance to penicillin has had a profound impact on the outcome of meningitis, it has had little impact on the mortality from pneumococcal pneumonia because the serum and pulmonary levels achieved with penicillin (or related drugs) are several times higher than the minimal inhibitory concentration of the strains. Thus, based on current levels of resistance to penicillin and cephalosporin, most patients with mild/moderate pneumococcal pneumonia may respond to oral amoxicillin, and most with severe pneumonia may be successfully treated with intravenous ceftriaxone, cefotaxime, or amoxicillin-clavulanic acid. It is of concern that patients infected with erythromycin-resistant pneumococci may not respond to therapy with a macrolide. In our opinion, except for well-selected patients, imipenem and vancomycin should not be widely used for the treatment of pneumococcal pneumonia. Some new drugs such as the new quinolones may play an important role in the management of pneumonia in the near future.