Bacterial resistance to antibiotics in acute respiratory infections (ARIs)

In this review article, we make suggestions on how to approach the increasing problem worldwide of bacterial acute respiratory infections resistant to antibiotics. After a brief description of the main mechanisms of bacterial resistance, i.e., enzymatic inactivation by beta-lactamases, reduction in the permeability of the outer membrane and the development of PBPs that have decreased affinity for the antibiotic, we analyze documented experiences on the response to different groups of antibiotics (beta- lactam antibiotics, cephalosporins, carbapenems and quinolones), of the most commonly isolated bacteria from invasive respiratory infections (Haemophilus influenzae, Streptococcus pneumoniae and Moraxela (Branhamella) catarrhalis. Antimicrobial agent susceptibility in vivo and in vitro testing and the correlation of their results provide the basic information for the adoption of adequate policies and strategies for better use of antibiotics in bacterial respiratory infections; proper surveillance would allow to make intelligent changes in such a policy. Standardized recommendations for clinical practice on the use of antibiotics could be misleading, iatrogenic, and could complicate the resistance problem. To prevent and control the rise and spread of bacterial resistance, an interdisciplinary approach is needed.