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Bacteremic pneumococcal pneumonia associated with macrolide failure

J Dylewski1, R Davidson

  • 1Department of Medicine, St. Mary's Hospital, 3830 Lacombe, Montreal, Quebec H3T 1M5, Canada. joe.dylewski@ssss.gouv.qc.ca

European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology
|January 18, 2006
PubMed

Insights

Macrolide resistance in Streptococcus pneumoniae is a growing concern for community-acquired pneumonia treatment. Two cases show clarithromycin failure, highlighting the clinical importance of antibiotic resistance.

Area of Science:

  • Infectious Diseases
  • Microbiology
  • Pulmonology

Background:

  • Current guidelines recommend macrolides for empiric outpatient community-acquired pneumonia (CAP).
  • Rising rates of macrolide resistance in Streptococcus pneumoniae are documented.
  • The clinical significance of S. pneumoniae macrolide resistance remains debated.

Observation:

  • Two cases of CAP caused by S. pneumoniae are presented.
  • Both cases were treated with clarithromycin, a macrolide antibiotic.
  • One patient experienced treatment failure with a fatal outcome.

Findings:

  • The study reports treatment failures in CAP due to S. pneumoniae despite macrolide therapy.
  • These cases suggest that macrolide resistance in S. pneumoniae can have significant clinical consequences.
  • The findings challenge the routine use of macrolides as first-line empiric therapy for CAP.

Implications:

  • Re-evaluation of current CAP treatment guidelines may be necessary.
  • Alternative empiric antibiotic choices should be considered for CAP.
  • Increased surveillance for macrolide resistance in S. pneumoniae is warranted.

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