151.2 📚 國考版

151.2.0.1 必背 — 細菌特徵

• Gram + lancet diplococcus, optochin S, bile soluble, α-hemolytic
• Capsule = key virulence factor
• IgA protease + pneumolysin

151.2.0.2 必背 — 臨床

• CAP #1 cause (typical pneumonia)
• Adult community meningitis #1 cause
• AOM 小孩 #1 cause

151.2.0.3 必背 — Empirical Treatment

Setting	Empirical
OPD CAP	Amox high-dose ± macrolide / Respiratory FQ
Inpt CAP	Ceftriaxone + azithro / Respiratory FQ
Meningitis	Vanco + Ceftriaxone + Dexamethasone
AOM	Amox high-dose ± clavulanate

151.2.0.4 必背 — 疫苗 (2024)

• PCV20 主流; PCV21 (V116) 老年新選擇
• ≥ 65 歲 single PCV20 dose ✓
• 19-64 高危 PCV20 ✓
• 無脾、HIV、CKD → 必打

151.2.0.5 必考併發症

• Austrian’s syndrome: pneumonia + meningitis + endocarditis (S. pneumoniae) → 找心臟雜音
• Cirrhosis SBP: S. pneumoniae 雖少但 listeria/pneumococcus 仍要 cover
• Cochlear implant + meningitis: vaccinate before implant

---