Streptococcus pneumoniae

Bacteria gram:

Pneumococcal infections are caused by Streptococcus pneumoniae, a gram-positive, catalase-negative

organism commonly referred to as pneumococcus.

Disease it causes:

Pneumococcal disease is an infection caused by Streptococcus pneumoniae bacteria

(“pneumococcus”). These bacteria can cause many types of illnesses, including pneumonia (infection of
the lungs), ear infections, sinus infections, meningitis (infection of the covering around the brain and
spinal cord), and bacteremia (blood stream infection). Pneumococcus bacteria are spread through
coughing, sneezing, and close contact with an infected person.

Mode of transmission:

Transmission of Streptococcus pneumoniae occurs as a result of direct person-to-person contact via

respiratory droplets and by autoinoculation in persons carrying the bacteria in their upper respiratory
tract.

Drug of choice:

Pneumococcal Infections (Streptococcus pneumoniae) Medication

β-lactam antibiotics are the mainstay of treatment in S pneumoniae infections. Until the 1970s, essentially
all pneumococcal isolates were sensitive to easily achievable levels of most commonly used antibiotics,
including penicillin, macrolides, clindamycin, cephalosporins, rifampin, vancomycin, and trimethoprim-
sulfamethoxazole.

Otitis media

For the treatment of otitis media recommends first-line treatment of most patients with amoxicillin 80-
90 mg/kg/day.

Sinusitis

The typical pathogens that cause sinusitis mimic those of otitis media; therefore, initial therapeutic
recommendations are similar. In adult allergic patients and in adults who do not respond to initial therapy,
fluoroquinolones provide appropriate coverage. In this clinical situation, this class of antibiotics is not
approved for children.

Pneumonia

The first line antibiotic recommended is amoxicillin (90 mg/kg/day in 2 doses or 45 mg/kg/day in 3 doses)
for previously healthy, appropriately immunized infants, preschool children, school-aged children, and
adolescents with mild-to-moderate CAP suspected to be of bacterial origin.

In fully immunized, previously healthy children and adolescents ill enough to warrant hospitalization,
ampicillin or penicillin G is recommended for first-line treatment when specific local epidemiology does
not show evidence of high-level resistance to penicillin.

Meningitis

The recommended initial therapy of presumed bacterial meningitis in children is with vancomycin plus
ceftriaxone or cefotaxime at meningeal doses. A beta-lactam (penicillin or, more likely, ceftriaxone or
cefotaxime [for CSF penetration]) ± vancomycin (adequate CSF levels).

For the treatment of pneumococcal meningitis in children who are allergic to beta-lactams, a combination
of vancomycin and rifampin should be considered.

Mechanism of Action:

β-Lactam antibiotics interfere with the assembly of peptidoglycan, the main constituent of the bacterial
cell wall. The peptidoglycan is a network of glycan chains reticulated by peptide links, constituting a single
macromolecule that encases the cell. This essential layer protects bacteria from turgor pressure and
provides a scaffold to anchor other surface molecules. Fine-tuning the dynamics of peptidoglycan
assembly is essential for proper cell division and shape determination. In ovoid bacteria, the synthesis of
peptidoglycan is thought to involve two machineries that allow bacteria to elongate and divide. A set of
six penicillin-binding proteins (PBPs) catalyzes the last step of peptidoglycan assembly in S. pneumoniae.
Antibiotics such as amoxicillin has Beta-lactams that act by binding to penicillin-binding proteins that
inhibit a process called transpeptidation, leading to activation of autolytic enzymes in the bacterial cell
wall. This leads to lysis of the cell wall, and thus, the destruction of the bacterial cell. This type of killing is
referred to bactericidal killing.
References
(n.d.). Pneumococcal Infections (Streptococcus pneumoniae) Medication: Antibiotics, Vaccines.
Retrieved from https://emedicine.medscape.com/article/225811-medication

Philippe, Gallet, & Chen. (2015). Mechanism of β-Lactam Action in Streptococcus pneumoniae: the
Piperacillin Paradox. Retrieved from https://aac.asm.org/content/59/1/609

Akhavan. (2019). Amoxicillin. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK482250/