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Chapter 19 : Pneumococcal Infections: Therapeutic Strategies and Pitfalls

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Abstract:

is one of the most important bacterial causes of respiratory infection and invasive disease in children and adults. This chapter reviews how increased rates of antibiotic-resistant have influenced the morbidity and mortality associated with pneumococcal disease and to present optimal therapeutic approaches for management of these infections in children and adults. In an eight-center children’s hospital surveillance study of pneumococcal infections, Kaplan et al. reported the outcome of 100 children with bacteremia secondary to penicillin- and cephalosporin-nonsusceptible infections. Informative studies suggest that an immunocompetent child between the ages of 3 and 36 months with culture-proven pneumococcal bacteremia, without meningitis, due to a nonsusceptible isolate can be effectively treated with a parenteral broad-spectrum cephalosporin as an appropriate initial therapy. Prior to beginning this therapy, repeat blood cultures should be obtained to document persistent bacteremia. Clinical presentation, cerebrospinal fluid indices on admission, hospital course, morbidity rates, and mortality rates were similar for patients infected with penicillin- or ceftriaxone-susceptible versus -nonsusceptible organisms. The relatively small numbers of nonsusceptible isolates and the inclusion of vancomycin in the treatment regimen for the majority of the patients limited the power of this study to detect significant differences between the groups. Pneumococcal isolates tolerant to vancomycin have been reported in cases of meningitis associated with poor therapeutic responses. Whether the increased use of conjugate vaccines and the reduced rates of inappropriate antibiotic use will lead to decreased antibiotic resistance to the pneumococcus in the future remains to be determined.

Citation: Edwards K. 2004. Pneumococcal Infections: Therapeutic Strategies and Pitfalls, p 314-330. In Tuomanen E, Mitchell T, Morrison D, Spratt B (ed), The Pneumococcus. ASM Press, Washington, DC. doi: 10.1128/9781555816537.ch19

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: pathogen with significant disease burden in children in the United States. Available from http://www.pneumo.com; data obtained from 46:1–24.

Citation: Edwards K. 2004. Pneumococcal Infections: Therapeutic Strategies and Pitfalls, p 314-330. In Tuomanen E, Mitchell T, Morrison D, Spratt B (ed), The Pneumococcus. ASM Press, Washington, DC. doi: 10.1128/9781555816537.ch19
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FIGURE 2

Bacteriological response to antibiotics in 324 patients with pneumococcal acute otitis media studied by the double tympanocentesis method. Agents used include cefuroxime axetil (Cefur-Axet) (30 mg/kg/day), amoxicillin (Amox) (40 mg/kg/day), augmentin (Aug) (45 mg/kg/day), intramuscular ceftriaxone at one dose of 50 mg/kg [CRO (×1)], intramuscular ceftriaxone at three daily doses of 50 mg/kg [CRO (×3)], oral azithromycin (Axithro) at 10 mg/kg/day for 3 days or 10 mg/kg/day for 1 day and 5 mg/kg/day for the following 4 days, and oral trimethoprim-sulfamethoxazole (TMP/SMX) at 8/40 mg/kg. (Chart modified from reference 15.)

Citation: Edwards K. 2004. Pneumococcal Infections: Therapeutic Strategies and Pitfalls, p 314-330. In Tuomanen E, Mitchell T, Morrison D, Spratt B (ed), The Pneumococcus. ASM Press, Washington, DC. doi: 10.1128/9781555816537.ch19
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References

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Tables

Generic image for table
TABLE 1

Factors evaluated for mortality in 360 patients receiving antibiotic monotherapy on multivariate analyses

Citation: Edwards K. 2004. Pneumococcal Infections: Therapeutic Strategies and Pitfalls, p 314-330. In Tuomanen E, Mitchell T, Morrison D, Spratt B (ed), The Pneumococcus. ASM Press, Washington, DC. doi: 10.1128/9781555816537.ch19
Generic image for table
TABLE 2

Antibiotic therapy for pneumococcal infections in children

Citation: Edwards K. 2004. Pneumococcal Infections: Therapeutic Strategies and Pitfalls, p 314-330. In Tuomanen E, Mitchell T, Morrison D, Spratt B (ed), The Pneumococcus. ASM Press, Washington, DC. doi: 10.1128/9781555816537.ch19
Generic image for table
TABLE 3

Antibiotic therapy for pneumococcal infections in adults

Citation: Edwards K. 2004. Pneumococcal Infections: Therapeutic Strategies and Pitfalls, p 314-330. In Tuomanen E, Mitchell T, Morrison D, Spratt B (ed), The Pneumococcus. ASM Press, Washington, DC. doi: 10.1128/9781555816537.ch19

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