Pneumococcal Pneumonia.

Pneumococcal pneumonia accounts for about one-sixth to two-thirds of all cases of community-acquired pneumonia. Its high frequency of occurrence worldwide and the high number of deaths associated with it--especially with bacteremic (invasive) disease--mark its importance. Invasive disease is associated with case-fatality rates of 15% to 25% among elderly adults. Penicillin-resistant Streptococcus pneumoniae (PRSP) first appeared in the 1970s, and its increased incidence in the late 1980s signaled its emerging importance. In individual patients in whom PRSP infection is suspected, the clinician must follow guidelines for empiric antibiotic therapy for community-acquired pneumonia until microbiological test results are known. When a diagnosis of pneumococcal pneumonia is established, the clinician should change to a regimen that targets the pneumococcus. Adults at highest risk for death from pneumococcal pneumonia include immunocompetent persons with underlying chronic diseases, immunocompromised persons, elderly persons, and unvaccinated residents of nursing homes and other chronic care facilities. Safe and effective, polyvalent polysaccharide pneumococcal vaccine should be used in persons 2 years of age and older who are at increased risk for serious pneumococcal pneumonia and in all persons 65 years of age and older.