Pneumococcal infections.

Overwhelmingly consistent evidence from observational studies has demonstrated that the pneumococcal conjugate vaccine has reduced the burden of pneumococcal disease but continues to affect the epidemiology of pneumococcal infections caused by nonvaccine serotypes and antibiotic-resistant pneumococci. On the basis of strong evidence, susceptible pneumococci causing uncomplicated, noninvasive childhood infections (eg, otitis or pneumonia) should be treated with a narrow-spectrum antimicrobial (eg, amoxicillin). Severely ill patients and those with infections caused by resistant pneumococci may be treated with parenteral antibiotic agents based on the isolate’s susceptibility and the site of the infection.