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Diagnosis and Medical Management

Diagnosis

A definitive diagnosis of infection with Streptococcus pneumoniae generally relies on isolation of the organism from blood or other normally sterile body sites. Tests are also available to detect capsular polysaccharide antigen in body fluids.

A urinary antigen test based on immunochromatographic membrane technique to detect the C-polysaccharide antigen of Streptococcus pneumoniae as a cause of community-acquired pneumonia among adults is commercially available and has been cleared by the Food and Drug Administration. The test is rapid and simple to use, has a reasonable specificity in adults, and has the ability to detect pneumococcal pneumonia after antibiotic therapy has been started.

Available data show that pneumococcal bacteria are resistant to one or more antibiotics in 30% of cases.

Medical Management

Available data [5.24 MB, 114 pages] show that pneumococcal bacteria are resistant to one or more antibiotics in 30% of cases. Treatment will usually include a broad-spectrum cephalosporin, and often vancomycin, until results of antibiotic sensitivity testing are available.

Resistance to penicillin and other antibiotics was previously very common. However, following introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) in 2000, antibiotic resistance declined and then began to increase again. Then, in 2008, the definition of penicillin resistance was changed such that a much larger proportion of pneumococci are now considered susceptible to penicillin. The revised susceptibility breakpoints for Streptococcus pneumoniae, published by the Clinical and Laboratory Standards Institute (CLSI) in January 2008, were the result of a reevaluation that showed clinical response to penicillin was being preserved in clinical studies of pneumococcal infection, despite reduced susceptibility response in vitro.

For more information on medical management of pneumonia, please see the guidelines below.


Guidelines

Community-Acquired Pneumonia (CAP)

Healthcare-Associated Pneumonia (HCAP)

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