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Pneumococcal resistance: the treatment challenge.
1Department of Pharmacy, Clinical Pharmacology Research Center, Bassett Healthcare, Cooperstown, NY 13326-1394, USA. guy.amsden@bassett.org
The Annals of Pharmacotherapy
|April 17, 2001
Summary
Pneumococcal antibiotic resistance is increasing, but appropriate antimicrobial dosing and pneumococcal vaccines can help manage this challenge. Correctly used older antibiotics may still be effective against resistant strains.
Area of Science:
- Microbiology
- Infectious Diseases
- Pharmacology
Background:
- Increasing incidence of pneumococcal antibiotic resistance poses a significant clinical challenge.
- Resistance trends have led to shifts in treatment strategies, often involving newer antibiotics.
- Controversies exist regarding the necessity of switching to newer antibiotic classes.
Purpose of the Study:
- To review in vitro and in vivo data on pneumococcal antibiotic resistance.
- To analyze the incidence, mechanisms, and controversies of this growing problem.
- To provide clinicians with recommendations for treatment and prevention.
Main Methods:
- Comprehensive literature search of MEDLINE (1966-August 2000) and secondary resources.
- Inclusion of primary and review articles.
- Evaluation of all identified relevant information for synthesis.
Main Results:
- Growing incidence of multi-drug resistant pneumococcal isolates is a troubling trend.
- Shifting to newer antibiotics may not always be necessary for resistant pneumococci.
- Pharmacokinetic and pharmacodynamic data suggest some older antibiotics may remain effective with correct usage.
Conclusions:
- Appropriate antimicrobial dosing is crucial for managing pneumococcal resistance.
- Optimal use of pneumococcal vaccines can help slow resistance development.
- Judicious use of antimicrobials can prolong the efficacy of existing agents.