Jenkins et al listed risk factors for drug-resistant Streptococcus pneumoniae (DRSP) based on a guideline from the IDSA/ATS. These can help select initial antibiotic therapy for a patient with a community-acquired Streptococcal pneumoniae pneumonia. The authors are from the University of Colorado.

Risk factors:

(1) age > 65 years

(2) antibiotic therapy within the past 3 months

(3) diabetes mellitus

(4) chronic obstructive pulmonary disease (COPD)

(5) alcohol abuse

(6) asthma or other chronic lung disorder

(7) coronary artery disease (CAD)

(8) congestive heart failure (CHF)

(9) dialysis-dependent renal failure

(10) HIV infection

(11) cirrhosis

(12) malignancy

(13) immunosuppressive therapy



• Other immunodeficiency state could be added to the list.

• Chronic liver disease could probably be added to cirrhosis.


number of risk factors =

= SUM(number of factors present)



• minimum number of risk factors: 0

• The risk of DRSP increases with the number of risk factors present.

• A patient with a community-acquired pneumonia can be treated with a macrolide or doxycycline.

• A patient with risk factors for DRSP should be treated with either a respiratory fluoroquinolone OR (beta-lactam plus macrolide).

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