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Clinical significance of antimicrobial resistance in Streptococcus pneumoniae

M R Jacobs1

  • 1Department of Pathology, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland, Ohio, USA. mrj6@cwru.edu

South African Medical Journal = Suid-Afrikaanse Tydskrif Vir Geneeskunde
|February 6, 2008
PubMed

Insights

High-dose penicillin G remains effective for most pneumococcal infections despite rising resistance. Judicious antimicrobial use and updated guidelines are crucial for managing drug-resistant strains and preventing further resistance.

Area of Science:

  • Microbiology
  • Infectious Diseases
  • Pharmacology

Background:

  • Increasing antimicrobial resistance in Streptococcus pneumoniae (pneumococcus) over 30 years.
  • Penicillin G remains effective for many non-meningeal pneumococcal infections despite resistance.
  • Established clinically relevant antimicrobial susceptibility breakpoints for pneumococcal diseases.

Purpose of the Study:

  • To review the effectiveness of penicillin G and other antimicrobial agents against pneumococcal diseases.
  • To discuss updated clinical breakpoints for antimicrobial susceptibility testing.
  • To highlight challenges posed by multidrug-resistant pneumococcal strains and inform treatment guidelines.

Main Methods:

  • Analysis of clinical studies and pharmacokinetic/pharmacodynamic parameters.
  • Review of updated Clinical and Laboratory Standards Institute (CLSI) breakpoints for penicillin G.
  • Assessment of global trends in pneumococcal resistance to common antimicrobial agents.

Main Results:

  • High-dose parenteral penicillin G shows continued effectiveness for non-meningeal infections.
  • New 2008 CLSI breakpoints established for parenteral penicillin G in non-meningeal infections.
  • Pneumococcal resistance to beta-lactams, macrolides, and co-trimoxazole is common, but most infections remain treatable.

Conclusions:

  • Judicious use of existing antimicrobial agents is key to long-term management.
  • Emerging drug resistance and potential virulence of replacement serotypes necessitate updated empiric treatment guidelines.
  • Physician and patient compliance with guidelines is vital to curb further resistance development.

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