Pneumococcal resistance in perspective: how well are we combating it?

Because Streptococcus pneumoniae is the most commonly isolated community-acquired respiratory tract pathogen, the reports of high rates of antibiotic resistance throughout the world highlight the need for intervention to stem any further increases in resistance. Efforts to reduce the incidence of pneumococcal resistance have been mainly 2-fold, involving attempts to reduce unnecessary antibiotic prescribing, as well as to assure early childhood immunization with the pneumococcal heptavalent conjugate vaccine. To reduce unnecessary prescribing for infections that are typically viral in etiology, such as acute bronchitis, education efforts have been focused not only on clinicians but also on parents and patients. These education efforts significantly reduce unnecessary antibiotic prescribing, and initial evidence suggests that they may stabilize, if not reduce, the incidence of penicillin and macrolide-resistant pneumococcal isolates. Utilization of the relatively new pneumococcal heptavalent conjugate vaccine not only reduces the incidence of acute otitis media caused by pneumococcal serotypes included in the vaccine as well as disease caused by related serotypes but also has a highly significant effect on reducing the incidence of invasive pneumococcal disease in children and potential adult contacts. In addition more recent data have established that vaccination is also decreasing the carriage and transmission of antibiotic-resistant pneumococcal isolates. Education and vaccine programs that attempt to stabilize and/or reduce the rate of pneumococcal resistance are at least as important as having effective antibiotic treatments for pneumococcal disease. These efforts to address pneumococcal resistance have been highly successful to date.