Albert Lai, MD

Sir William Osler once called pneumococcalpneumonia “the captain of themen of death.”1 Pneumonia is the sixthleading cause of death in the UnitedStates and the fourth leading causeamong Americans 80 years of age andolder.2

ABSTRACT: The emergence of drug-resistant pneumococci has changed the empiric treatment of community-acquired pneumonia. Newer fluoroquinolones with activity against Streptococcus pneumoniae offer an alternative in the treatment of infection with penicillin-resistant strains. These agents are not recommended as first-line therapy because of concerns about the development of resistance. Reserve the fluoroquinolones for patients who are allergic to macrolides and β-lactams, have failed to respond to a first-line agent, or have a documented infection with a highly resistant strain. The pneumococcal vaccine is recommended for all persons aged 65 years and older, adults with chronic car-diopulmonary diseases, and immunocompromised persons. Consider revaccination every 6 years in asplenic patients and immunocompromised persons. In addition, vaccination against influenza can help prevent secondary pneumonia and reduce the need for hospitalization.