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 2008 to December 2008

%
	Blood				Non-blood
	n	S	I	R	n	S	I	R
Penicillin -CLSI 2008 pneumonia criteria	46	93	4	2	129	92	7	1
Ceftriaxone	45	93	4	2	69	87	12	1
Levofloxacin	46	100+	0	0	129	98++	0	2
Erythromycin	46	83	0	17	129	61	1	38
Clindamycin*	36	83	0	17	92	80	0	20
Cotrimoxazole (Sulfa-TMP)	46	85	2	13	128	75	0	25
Chloramphenicol	21	95	0	5	37	92	0	8
Vancomycin	27	100	0	0	67	100	0	0

*erythromycin-resistant isolates were tested for induction of clindamycin resistance - no induced resistance was detected; +6/46 susceptible isolates had levofloxacin MIC=2; ++ 3/106 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
Clindamycin	<=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

Archived pneumococcal susceptibility data 2007

updated 2/9/09 P. Edelstein