Pneumococcal Pneumonia

Aka: Pneumococcal Pneumonia, Streptococcal Pneumonia

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II. Epidemiology

  1. Most common cause of Community Acquired Pneumonia

III. Classic Symptoms

  1. Shaking rigors
  2. Fever
  3. Purulent Sputum
    1. Rust colored
  4. Pleuritic Chest Pain
  5. Dyspnea
  6. Chest Splinting

IV. Lab

  1. Complete Blood Count
    1. White Blood Cell Count elevated with Left Shift
  2. Gram Stain
    1. Gram Positive encapsulated organisms
    2. Elongated lancet shaped diplococci
  3. Blood Culture
    1. Positive in only 33% of cases
  4. Sputum Culture
    1. Positive in only 40% of Pneumococcal Pneumonias

V. Radiology

  1. Chest XRay
    1. Lobar consolidation (often lower lobe)
    2. Patchy infiltrates

VI. Management

  1. Increasing Penicillin Resistance
    1. See Penicillin Resistant Pneumococcus
  2. Penicillin Sensitive
    1. Ampicillin IV or Amoxicillin PO
    2. Erythromycin
    3. Azithromycin
    4. Clarithromycin
    5. Penicillin G IV
    6. Doxycycline
    7. Oral Second Generation Cephalosporin
    8. Parenteral Third Generation Cephalosporin
  3. High-Level Penicillin Resistance
    1. Broad spectrum Fluoroquinolone
      1. Levofloxacin
      2. Gatifloxacin
      3. Grepafloxacin
      4. Moxifloxacin
      5. Sparfloxacin
    2. Parenteral Third Generation Cephalosporin
    3. High dose Ampicillin
    4. Vancomycin IV with or without Rifampin

VII. References

  1. Gilbert (2001) Sanford Antimicrobial, p. 28

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