Pneumococcal infections treatment

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. 

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... 

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 ... 

Penicillin prophylaxis until at least 5 years of age is also recommended in children with SCD, even if they have been immunized with the 7-valent vaccine as prophylaxis against pneumococcal infections. Prophylactic treatment should begin at 2 months of age or earlier. An effective regimen that yields an 84% decrease in observed incidence of pneumococcal infections is penicillin V potassium at a dosage of 125 mg orally twice daily until the age of 3 years, followed by 250 mg twice daily until the age of 5 years. An alternate regimen... 

In penicillin-allergic patients, vancomycin is an effective alternative for the treatment of endocarditis caused by viridans streptococci or, combined with an aminoglycoside, for enterococcal endocarditis. Vancomycin has become an important antibiotic in the management of known or suspected penicillin-resistant pneumococcal infections. 

In 1932, while a student of Fleming, C. G. Paine used crude filtrates of broth cultures of P. notatum for the treatment of several infections by local application at the Jessop Hospital in Sheffield, with a good result in one case of a pneumococcal infection of the eye. But a few years later the possibility that penicillin might have therapeutic use seems to have been forgotten and Fleming turned his attention to the sulfonamides. 

The use of antibiotics is not recommended, except for the treatment of infectious exacerbations of COPD and other bacterial infections. Influenza vaccines decrease illness and death in COPD patients. Pneumococcal vaccination is also recommended. 

Disease that is segmental or lobar in its distribution is usually caused by Streptococcus pneumoniae (pneumococcus). Haemophilus influenzae is a rare cause in this group, although it more often leads to exacerbations of chronic bronchitis and does cause pneumonia in patients infected with HIV. Benzyl-penicillin i.v. or amoxicillin p.o. are the treatments of choice if pneumococcal pneumonia is very likely alternatively, use erythromycin/clarithromycin in a penicillin-allergic patient. Seriously ill patients are best given benzylpenicillin (to cover the pneumococcus) plus ciprofloxacin (to cover Haemophilus and atypical pathogens). Where penicillin-resistant pneumococci are prevalent, i.v. cefotaxime is a reasonable best guess choice. 

Penicillins. — Dicloxacillin (III) was effective in 48 of 49 patients afflicted with pneumococcal and staphylococcal wound infections. Against clinical isolates of aureus and epidermidis, dicloxacillin was 2 to 3.5 times more active than cloxacillin (ll) and oxacillin (1). Other clinicians found dicloxacillin highly efficacious for oral treatment of infections caused by streptococci and penicillinase-producing staphylococci. qjj. 

Bass R, Engelhard D, Trembovler V, Shohami E (1996) A novel nonpsychotropic cannabinoid, HU-211, in the treatment of experimental pneumococcal meningitis. J Infect Dis 173 735-738... 

Penicillin, a naturally occurring antibiotic, is indicated in the treatment of group A streptococcal upper respiratory infections, prophylaxis of poststreptococcal rheumatic fever, syphihs of less than one year s duration, moderate to severe systemic infections, uncomphcated gonorrhea, pneumococcal pneumonia, and endocarditis prophylaxis for dental surgery (see Table 23). 

C. Clinical Uses Because of its toxicity, chloramphenicol has very few uses as a systemic drug. It is a backup drug for severe infections caused by salmonella and for the treatment of pneumococcal and meningococcal meningitis in beta-lactam-sensitive persons. Some H influenzae strains are... 

Ampicillin is essentially equivalent to benzylpenicillin for pneumococcal, streptococcal, and meningococcal infections, and many strains of Gram-negative Salmonella, Shigella, Proteus mirabllls, and Escherichia coll, as well as many strains of Haemophilus influenzae and Neisseria gonorrhoeae, respond well to oral treatment with ampicillin. 

Data from the 1950s suggested that the tetracyclines can reduce the effectiveness of penicillins in the treatment of pneumococcal meningitis and probably scarlet fever. It is uncertain whether a similar interaction occurs with other infections. This interaction may possibly be important only with those infections where a rapid kill is essential. 

Causes of death have been cachexia (Knox and Ramsey 1932), pneumonia (SiEGMUND 1921), heart failure (Niemann 1914, Bloom 1928), pneumococcal meningitis (Bloom 1928), enteritis (Giampalmo 1953) or other infections to which the debilitated infants are very susceptible. Today, prevention or treatment of complications may result in a more protracted course of the disease, and sequelae of the primary lesion may preponderate as cause of death. 

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