Penicillin- and Cephalosporin-Resistant Streptococcus Pneumoniae
The global emergence of pneumococci resistant to antimicrobial therapy has led to dilemmas in the management of pneumococcal infections. The principles of pharmacodynamics predict that penicillin and cephalosporin therapy of pneumonia will be successful against pneumococci with minimum inhibitory concentrations of penicillin up to 4 μg/ml. These predictions are supported by the observations of a number of recent clinical studies. Otitis media therapy is influenced by penicillin-resistance and current recommendations are that amoxicillin is the drug of choice for this infection, given at a double dose of 80 to 90 mg/kg/day. For the therapy of meningitis, cefotaxime or ceftriaxone in maximal doses is recommended and vancomycin may be added if cephalosporin-resistant strains are encountered with reasonable frequency in the population. The new fluoroquinolones with excellent antipneumococcal activity may be considered for use in the setting of pneumonia caused by highly resistant pneumococci and are under evaluation for the management of meningitis.
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- 13.Friedland IR, Klugman KP. Cerebrospinal fluid bactericidal activity against cephalosporin-resistant Streptococcus pneumoniae in children with meningitis treated with high dosage cefotaxime. Antimicrob Agents Chemother; 41: 1888–91Google Scholar
- 18.Silverstein M, Chumpa A, Bachur R, et al. Clinical implications of penicillin and ceftriaxone resistance among children with pneumococcal bacteremia [abstract K-90]. Toronto, Canada: ICAAC, 1997; P343Google Scholar
- 21.Destache CJ, Pakiz CB, McConnell S et al. Effect of penicillin (PCN) susceptibility on hospitalization length and mortality in Streptococcus pneumoniae infections [abstract K-89]. 37th International Conference on Antimicrobial Agents and Chemotherapy 1997 Sep 28–Oct 1; Toronto, P343Google Scholar
- 23.Mularczyk M, Leophonte P, Rouquet RM, et al. Resistant and susceptible penicillin pneumococcal pneumonia-comparative study [abstract K-88]. 37th International Conference on Antimicrobial Agents and Chemotherapy 1997 Sep 28–Oct 1; Toronto, P343Google Scholar