Penicillin Dosing for Pneumococcal Pneumonia

Bryan, Charles S.; Talwani, Rohit; Stinson, M. Shawn

doi:10.1378/chest.112.6.1657

Cited by 50 publications

(20 citation statements)

References 64 publications

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“…[14][15][16][17][18] The main reasons for abandoning penicillin in the treatment of pneumococcal pneumonia are the progressive increase of penicillin resistance in S. pneumoniae and the absence of a consensus on optimal dosage. 23 Pharmacokinetics and pharmacodynamics data suggest that, in the treatment of pneumonia, beta-lactam antibiotics are effective against pneumococci with MICs of up to 4 µg/mL. In children, therapeutic levels have been achieved at doses ranging from 100,000 to 300,000 IU/kg/day in 4 to 6 divided doses.…”

Section: Agentmentioning

confidence: 99%

Análise das cepas de Streptococcus pneumoniae causadores de pneumonia invasiva: sorotipos e sensibilidade aos antimicrobianos

Yoshioka¹,

Martinez²,

Brandileone³

et al. 2011

J. Pediatr. (Rio J.)

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Objectives: To identify the most common pneumococcal serotypes in children hospitalized with invasive pneumonia, correlate isolated serotypes with those included in conjugate vaccines, and ascertain the sensitivity of the isolated pneumococcal strains to penicillin and other antibiotics. Methods:From January 2003 to October 2008, a retrospective study of hospitalized children with a diagnosis of Streptococcus pneumoniae pneumonia was conducted at the university hospital of Universidade de São Paulo. Criteria for inclusion were: age greater than 29 days and less than 15 years, radiological and clinical diagnosis of pneumonia, and isolation of Streptococcus pneumoniae in blood cultures and/or pleural effusion. Results:The study included 107 children. The most common serotypes were 14 (36.5%), 1 (16%), 5 (14.6%), 6B (6.3%) and 3 (4.2%). The proportion of identified serotypes contained in the heptavalent, 10-valent and 13-valent conjugate vaccines was 53.1, 86.5, and 96.9%, respectively. Pneumococcal strains were sensitive to penicillin (minimum inhibitory concentration, MIC ≤ 2 μg/mL) in 100 cases (93.5%) and displayed intermediate resistance (MIC = 4 μg/mL) in 7 cases (6.5%). No strains were penicillin-resistant (MIC ≥ 8 µg/mL) according to the Clinical and Laboratory Standards Institute 2008 standards. Tested isolates were highly sensitive to vancomycin, rifampicin, ceftriaxone, clindamycin, erythromycin, and chloramphenicol. Conclusions:Our results confirm a significant potential impact of conjugate vaccines, mainly 10-valent and 13-valent, on invasive pneumonia. Furthermore, susceptibility testing results show that penicillin is still the treatment of choice for invasive pneumonia in our setting.J Pediatr (Rio J). 2011;87(1):70-75: Streptococcus pneumoniae, pneumonia, serotype, antimicrobial resistance, pneumococcal conjugate vaccine.

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Section: Agentmentioning

confidence: 99%

Análise das cepas de Streptococcus pneumoniae causadores de pneumonia invasiva: sorotipos e sensibilidade aos antimicrobianos

Yoshioka¹,

Martinez²,

Brandileone³

et al. 2011

J. Pediatr. (Rio J.)

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“…In particular for ␤ -lactam agents, the effectiveness of the drug is maximized when the serum concentration is maintained above the MIC for at least 40-50% of the drug interval [28] . Therefore, S. pneumoniae isolates with relative or even complete penicillin resistance may be successfully treated with large doses and sufficiently frequent dosing intervals of penicillin or related ␤ -lactam drugs [29] .…”

Section: Discussionmentioning

confidence: 99%

Cefuroxime for Empiric Treatment of Community-Acquired Pneumococcal Pneumonia: Is There a Generation Gap?

Wiener-Well¹,

Raveh²,

Schlesinger³

et al. 2009

Chemotherapy

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Background:Streptococcus pneumoniae infection is an important cause of morbidity and mortality. The recommendations to use expanded-spectrum β-lactam drugs for patients with community-acquired pneumonia derived from the growing prevalence of penicillin-resistant pneumococci. Controversy exists regarding the use of second generation cephalosporins for empirical treatment of community-acquired pneumonia. Methods: In a retrospective study, 31 adult patients with pneumococcal pneumonia and bacteremia caused by S. pneumoniae that was intermediately resistant to penicillin were compared with 31 control patients with similar infection caused by penicillin-susceptible pneumococci. All patients were treated empirically with cefuroxime, alone or in combination with other antibiotics. Morbidity and mortality were studied. Results: All unsusceptible pneumococci isolates were intermediately resistant to penicillin. No cases of fully resistant pneumococci were isolated from blood cultures in our hospital. Two factors were significantly associated with non-susceptibility to penicillin: hematologic malignancy and immunosuppression. No significant difference in morbidity or mortality was detected between the 2 groups, and penicillin minimum inhibitory concentration was not found to be a factor associated with mortality. Conclusions: Patients with pneumococcal pneumonia caused by intermediately resistant pneumococci can be empirically treated with cefuroxime. In regions where fully resistant pneumococci are rare, the use of a second generation cephalosporin for empiric treatment of community-acquired pneumonia may be appropriate.

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“…The pharmacokinetics of penicillin in serum have recently been reviewed by BRYAN et al [14]. These data suggest that if a penicillin drug level exceeding the MIC of a resistant bacterium is required for 40% of the dosing interval, a penicillin dose of 2,000,000 units may be given 4-hourly to treat a highly resistant pneumococcus with an MIC of ¡4 mg?mL -1 [15].…”

Section: B-lactam Agentsmentioning

confidence: 99%

Bacteriological evidence of antibiotic failure in pneumococcal lower respiratory tract infections

2002

European Respiratory Journal

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Bacteriological evidence of antibiotic failure in pneumococcal lower respiratory tract infections. K.P. Klugman. #ERS Journals Ltd 2002. ABSTRACT: The global pandemic of antimicrobial resistance, particularly in the pneumococcus, has had a major impact on the management of community-acquired pneumonia.A number of prospective and retrospective studies have analysed the impact of penicillin resistance on clinical outcome in pneumonia. Pharmacodynamic principles predicting success when the antibiotic dose exceeds the minimum inhibitory concentration (MIC) for 40-50% of the dosing interval have proved remarkably accurate. There is no evidence of bacteriological failure of penicillins active against resistant strains. There is a single report of the failure of the less active agent, ticarcillin. High dose oral and intravenous amoxicillin should treat strains with MICs ¡4 mg?mL -1 , as should high doses of intravenous penicillin, ceftriaxone and cefotaxime. Strains of pneumococci resistant to these agents at an MIC o8 mg?mL -1 are rare at the present time. Most other cephalosporins are less active and should not be used empirically for drug-resistant Streptococcus pneumoniae. Bacteriological failures of cefazolin, cefuroxime and ceftazidime have been reported.There is increasing evidence of bacteriologically confirmed macrolide failure of pneumonia therapy at MICs o4 mg?mL -1 . The molecular basis of the resistance is irrelevant if the MIC is in that range or higher. Double mutants in the parC and gyrA genes lead to fluoroquinolone resistance that has been found to cause bacteriological failure of the fluoroquinolones, particularly levofloxacin and ciprofloxacin, in the management of pneumonia and exacerbations of chronic bronchitis. Two mutations in these genes can greatly increase the MICs of all the marketed fluoroquinolones, and raise the prospect of failure of therapy even with the more active ones. However, demonstration of bacteriological failure of gatifloxacin or moxifloxicin has not yet been reported.High dose, active b-lactams or fluoroquinolones with enhanced activity against Gram positive pathogens remain the drugs of choice for the management of communityacquired pneumonia caused by the drug-resistant pneumococcus.

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Penicillin Dosing for Pneumococcal Pneumonia

Cited by 50 publications

References 64 publications

Análise das cepas de Streptococcus pneumoniae causadores de pneumonia invasiva: sorotipos e sensibilidade aos antimicrobianos

Análise das cepas de Streptococcus pneumoniae causadores de pneumonia invasiva: sorotipos e sensibilidade aos antimicrobianos

Cefuroxime for Empiric Treatment of Community-Acquired Pneumococcal Pneumonia: Is There a Generation Gap?

Bacteriological evidence of antibiotic failure in pneumococcal lower respiratory tract infections

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