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Emerging resistance to antibiotics: impact on respiratory infections in the outpatient setting
1Department of Pediatrics, University of Pittsburgh School of Medicine, Pennsylvania, USA.
Objective:
To review the major mechanisms of antibiotic resistance and provide an overview of currently available oral antibiotics. This article discusses the impact of antibiotic resistance on respiratory infections (eg, otitis media, sinusitis, and pneumonia) encountered in the outpatient setting and appropriate management strategies for these infections are proposed.
Data Sources:
A Medline search was performed to identify recent references from the English language pertinent to this topic. Proposed management schemes for infections due to antibiotic-resistant bacteria were derived from current literature as well as the opinion of the authors.
Results:
Currently available oral antibiotics including penicillins, cephalosporins, macrolides, trimethroprim/sulfamethoxazole, and clindamycin continue to provide effective therapeutic options despite the increasing importance of antibiotic resistance in bacteria causing respiratory tract infections in the outpatient setting. The effectiveness of a given agent may no longer be assured, leading to the need for development of updated management strategies for patients experiencing treatment failure with antibiotics. Diagnostic strategies (ie, tympanocentesis) and novel treatment algorithms (eg, use of amoxicillin in combination with amoxicillin/clavulanate) for patients experiencing clinical failures potentially due to antibiotic-resistant bacteria are proposed.
Conclusions:
The increasing prevalence of antibiotic resistant bacteria (especially penicillin-resistant Streptococcus pneumoniae) is leading to new approaches to the management of common respiratory infections in the outpatient setting. Additional experience and careful clinical trials are necessary to identify optimal management strategies for these infections.
Insights
Antibiotic resistance is increasing in common respiratory infections, necessitating updated management strategies. New approaches and clinical trials are needed to ensure effective treatment for outpatient respiratory infections.
Area of Science:
- Infectious Diseases
- Pharmacology
- Microbiology
Background:
- Antibiotic resistance is a growing concern for common outpatient respiratory infections.
- Penicillin-resistant Streptococcus pneumoniae is a significant pathogen driving resistance.
Purpose of the Study:
- To review antibiotic resistance mechanisms and oral antibiotic options.
- To discuss the impact of resistance on respiratory infections and propose management strategies.
Main Methods:
- Medline search for recent English-language references.
- Management schemes derived from literature and author expertise.
Main Results:
- Current oral antibiotics remain options but effectiveness is not guaranteed.
- Updated strategies, diagnostic tools (tympanocentesis), and novel algorithms (amoxicillin/clavulanate) are proposed for treatment failures.
Conclusions:
- Increasing antibiotic resistance necessitates new management approaches for respiratory infections.
- Further clinical trials are required to optimize treatment strategies.