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Therapy of penicillin- and cephalosporin-resistant pneumococcal infections
1Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas 75235-9063.
Abstract:
Streptococcus pneumoniae has recently developed resistance to almost every agent that has been used for therapy, including the extended-spectrum cephalosporins. The empiric therapy of penicillin-resistant pneumococcal meningitis should include cefotaximine or ceftriaxone plus vancomycin pending cephalosporin susceptibility results. Intermediate penicillin-resistant pneumococcal infections outside the central nervous system will usually respond to high dose intravenous beta-lactam antibiotic therapy. Highly penicillin-resistant pneumococcal infections may not respond to penicillin therapy, in which case therapy with vancomycin, imipenem or a macrolide (if susceptible) can be considered. Pneumococcal resistance to commonly used oral agents varies geographically and the efficacy of a particular agent can only be assured once the infecting strain is known to be susceptible. It is imperative to determine the susceptibility of every pneumococcal isolate to the agent(s) being used for therapy, particularly in cases of meningitis and to document rapid sterilization of infected body sites or fluids.
Insights
Streptococcus pneumoniae is increasingly resistant to antibiotics. Treatment for penicillin-resistant pneumococcal meningitis requires cefotaximine or ceftriaxone plus vancomycin.
Area of Science:
- Infectious Diseases
- Microbiology
- Pharmacology
Background:
- Streptococcus pneumoniae exhibits rising resistance to numerous therapeutic agents, including extended-spectrum cephalosporins.
- This resistance poses significant challenges for effective treatment of pneumococcal infections.
Purpose of the Study:
- To outline current therapeutic strategies for Streptococcus pneumoniae infections, considering emerging antibiotic resistance.
- To provide guidance on selecting appropriate antibiotics based on susceptibility patterns.
Main Methods:
- Review of current literature and clinical guidelines regarding Streptococcus pneumoniae treatment.
- Analysis of antibiotic resistance trends and their implications for therapy.
Main Results:
- Empiric therapy for penicillin-resistant pneumococcal meningitis should involve cefotaximine or ceftriaxone combined with vancomycin.
- Intermediate penicillin-resistant infections may respond to high-dose intravenous beta-lactam antibiotics.
- Highly penicillin-resistant infections might necessitate vancomycin, imipenem, or susceptible macrolides.
- Geographic variation in oral agent resistance necessitates susceptibility testing for assured efficacy.
Conclusions:
- Determining pneumococcal isolate susceptibility is crucial for effective therapy, especially in meningitis cases.
- Monitoring for rapid sterilization of infected sites is imperative.
- Treatment strategies must adapt to evolving antibiotic resistance patterns in Streptococcus pneumoniae.