Graduate Medical Education

University of Pennsylvania Medical Center Guidelines for Antimicrobial Therapy

Streptococcus pneumoniae

Combined Data for the Hospital of the University of Pennsylvania , Presbyterian Medical Center, and the UPHS Outpatient Practices - January 2007 to December 2007

%
	Blood				Non-blood
	n	S	I	R	n	S	I	R
Penicillin -CLSI 2008 pneumonia criteria	48	96	4	0	110	91	6	3
Ceftriaxone	48	98	2	0	46	87	13	0
Levofloxacin	48	100+	0	0	110	96++	2	2
Erythromycin	48	79	0	21	110	63	3	34
Cotrimoxazole (Sulfa-TMP)	48	88	0	12	110	76	0	24
Chloramphenicol	23	96	0	4	44	93	0	7
Vancomycin	27	100	0	0	45	100	0	0

+11/48 susceptible isolates had levofloxacin MIC=2. ++ 33/106 susceptible isolates had MIC=2. Pneumococci with levofloxacin MICs =2 are very likely to have 1st step QRDR mutations.

2008 CLSI Breakpoints for S. pneumoniae
	S	I	R
Penicillin G-pneumonia	<=2	4	>=8
Penicillin G- meningitis & PenVK for pneumonia	<=0.06	0.12-1	>=2
Levofloxacin	<=2	4	>=8
Ceftriaxone	<=1	2	>=4
Chloramphenicol	<=4		>=8
Erythromycin	<=0.25	0.5	>=1
Cotrimoxazole	<=0.5/9.5	1/19.-2/38	>=4/76
Vancomycin	<=1

Isolates that are susceptible to penicillin can be considered susceptible to ampicillin, amoxicillin, amoxicillin/clavulanate, ampicillin/sulbactam, cefepime, cefotaxime, ceftriaxone, and imipenem for approved indications. Note that the CLSI changed the penicillin G breakpoints for pneumococcal pneumonia in 2008, which had the effect of placing many more isolates in the "S" category. There remain different breakpoints for pneumococcal meningitis, and there is a new category for the treatment of pneumococcal pneumonia with PenVK.

View Inpatient Susceptibility Results

Archived pneumococcal susceptibility data January 2001-Dec2006

updated 2/7/08 P. Edelstein