Key points
- Vaccines are recommended to prevent pneumococcal disease.
- Streptococcus pneumoniae is a common bacterial cause of acute otitis media, sinusitis, community-acquired pneumonia, and bacterial meningitis.
- Guidelines for treatment vary by syndrome.
Prevention
Vaccination
Vaccination is the best way to prevent pneumococcal disease. See Pneumococcal Vaccination: Information for Healthcare Professionals for information on all pneumococcal vaccine recommendations.
App provides patient-specific guidance
Chemoprophylaxis
CDC doesn't have guidance for chemoprophylaxis of close contacts of patients with pneumococcal disease. Secondary cases of invasive pneumococcal infection are uncommon.
For children with asplenia
The American Academy of Pediatrics typically recommends daily antimicrobial prophylaxis with oral penicillin V for children with functional or anatomic asplenia. This includes those with sickle cell disease.
In general, clinicians should consider antimicrobial prophylaxis for all children with asplenia younger than 5 years of age. It should continue for at least 1 year after splenectomy. Vaccination is also recommended.
Testing and diagnosis
Diagnosis
Definitively diagnosing S. pneumoniae infection generally relies on isolating the organism from blood or other normally sterile body sites. Tests are also available to detect capsular polysaccharide antigen in body fluids. There are also molecular detection methods using PCR.
Urinary antigen test
A commercially available urinary antigen test can detect the C-polysaccharide antigen of S. pneumoniae as a cause of community-acquired pneumonia.
The test
- Is rapid and simple to use
- Has a reasonable specificity in adults
- Can detect pneumococcal pneumonia after initiation of antibiotic therapy
Patient management
Guidelines for treatment vary by syndrome:
Antibiotic selection for serious infections
At the beginning, antibiotic treatment for serious pneumococcal infections typically includes broad-spectrum antibiotics. Once antibiotic testing is done, healthcare providers may choose a more targeted, or narrow-spectrum, antibiotic.