Pneumococcal infection

Penicillin is the dmg of choice for the treatment of group B streptococcal, meningococcal and pneumococcal infections but, as discussed earlier, CSF concentrations of penicillin are significantly influenced by the intensity of the inflammatoiy response. To achieve therapeutic concentrations within the CSF, high dosages are required, and in the case of pneumococcal meningitis should be continued for 10-14 days. 

Prophylaxis against pneumococcal infection reduces death during childhood. 

Because patient with SCD have impaired splenic function, they are less adequately protected against encapsulated organisms such as S. pneumoniae, Hemophilus influenzae, and Salmonella. The use of pneumococcal vaccine in SCD patients has decreased the rates of morbidity and mortality dramatically. However, there are still groups of SCD children who continue to have high rates of invasive pneumococcal infections.17 Two pneumococcal vaccines are available. The 7-valent conjugate... 

Children with SCD should receive prophylactic penicillin until at least the age of 5 years, even if they have been immunized appropriately with PCV 7 against pneumococcal infections. Penicillin V potassium typically is initiated at age 2 months with a dose of 125 mg orally twice daily until age 3 years and then 250 mg orally twice daily until 5 years of age. The intramuscular use of benzathine penicillin 600,000 units every 4 weeks from age 6 months to 6 years is also an option for non-compliant patients. Penicillin-allergic patients may receive erythromycin 10 mg/kg twice daily. Penicillin prophylaxis usually is not continued in children over the age of 6 years but may be considered in patients with a history of invasive pneumococcal infection or surgical splenectomy.6,18-20... 

Riddington C, Owusu-Ofori S. Prophylactic antibiotics for preventing pneumococcal infections in children with sickle cell disease. Cochrane Database 2002 3 CD003427. 

There are two pneumococcal vaccines, a 7-valent conjugated vaccine for children younger than 6 years of age and a 23-purified-capsular polysaccharide antigen vaccine for adults. The 23 capsular types in the vaccine represent at least 85% to 90% of the serotypes that cause invasive pneumococcal infections among children and adults in the United States.41 After vaccination, an antigen-specific antibody response, indicated by a twofold or greater rise in serotype-specific antibody, develops within 2 to 3 weeks in 80% or more of healthy young adults.42... 

Treatment of AOM depends on patient age, illness severity, and the certainty of diagnosis. Children younger than 2 years of age have a higher incidence of penicillin-resistant pneumococcal infections and have higher clinical and bacteri-ologic failure rates and complications when not treated initially with antibiotics as compared with older children.5,15 Patients with severe illness, defined by degree of fever and... 

Clindamycin 20-30 mg/kg per day in 3-4 doses (adult 300 mg four times daily or 450 mg three times daily) Nausea, diarrhea, C. difficile colitis, anorexia S Oral liquid has very poor taste only for pneumococcal infection... 

Q82 Prevenar is a pneumococcal vaccine that contains polysaccharide from seven capsular types of the pneumococcus that is conjugated to protein. Prevenar should only be administered to children who are at an increased risk of pneumococcal infection. 

Prevenar is the pneumococcal polysaccharide-conjugate vaccine and contains polysaccharide, from seven capsular types of pneumococci, which is conjugated to diphtheria toxin (protein). Prevenar is recommended for individuals at increased risk of pneumococcal infection including those over 65 years, patients with chronic heart, renal, respiratory or liver disease, diabetics and immune deficiency. It is a component of the primary course of childhood immunisation. 

Pneumococcal infections Moderately severe upper respiratory tract infections... 

Pneumococcal infections Mild to moderately severe respiratory tract infections including otitis media... 

A patient is being treated with the compound imipenem for penicillin-resistant pneumococcal infection and is responding well. After several days of treatment, the patient begins vomiting and has diarrhea. You observe a slight seizure at the same time. The infection is very severe, and you do not wish to terminate the imipenem but you fear that the adverse effects will make this a necessity. What do you do ... 

It is used in tonsillitis, otitis media, erysipelas, prophylaxis of rheumatic fever and pneumococcal infections. 

It is prepared from purified pneumococcal capsular antigens and includes 23 serotypes which are responsible for at least 85% of pneumococcal infections and has greater than 90% coverage against serotypes that are penicillin resistant. 

It is indicated in prevention of pneumococcal infections, particularly those of respiratory origin in all subjects over the age of two years who are at risk of serious pneumococcal infection. 

Cefaclor, cefuroxime axetil, cefprozil, and loracarbef can be given orally. The usual dosage for adults is 10-15 mg/kg/d in two to four divided doses children should be given 20-40 mg/kg/d up to a maximum of 1 g/d. Except for cefuroxime axetil, these drugs are not predictably active against penicillin-resistant pneumococci and should be used cautiously, if at all, to treat suspected or proved pneumococcal infections. Cefaclor is more susceptible to 13-lactamase hydrolysis compared with the other agents, and its usefulness is correspondingly diminished. 

Sickle cell patients are hyposplenic and receive prophylactic phenoxymethylpenicillin to help prevent pneumococcal infection. Folic acid is supplementation may be given as the high red cell turnover increases requirements - though many prescribers find this unnecessary as they consider the UK diet contains sufficient folic acid. 

Lund-Tonnesen, St. Liver abscess an unusual manifestation of pneumococcal infection. Scand. J. Infect. Dis. 1995 27 397-398... 

Sulfanilamide is an effective antibiotic and has been used safely for many years to treat streptococcal and pneumococcal infections. However, sulfanilamide is generated from the azo-reduction of Prontesil, which is an example of a prodrug. A prodrug has no therapeutic effect on its own but generates active metabolites. The metabolism of prontesil, a prodrug, to its active metabolite, sulfanilamide, can be used as an example of azo reduction (Figure 6). 

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