Copyright ©ERS Journals Ltd 2002 Bacteriological evidence of antibiotic failure in pneumococcal lower respiratory tract infectionsCORRESPONDENCE: K.P. Klugman, Dept of International Health Rollins School of Public Health, Room 764, Emory University, 1518 Clifton Rd NE, Atlanta, Georgia, 30322, USA. Fax: 1 4047274590. E-mail: kklugma@sph.emory.edu Keywords: antimicrobial resistance, fluoroquinolones, macrolides, penicillin, pneumonia, Streptococcus pneumoniae
Received: January 31, 2002
The global pandemic of antimicrobial resistance, particularly in the pneumococcus, has had a major impact on the management of community-acquired pneumonia.
A number of prospective and retrospective studies have analysed the impact of penicillin resistance on clinical outcome in pneumonia. Pharmacodynamic principles predicting success when the antibiotic dose exceeds the minimum inhibitory concentration (MIC) for 4050% of the dosing interval have proved remarkably accurate. There is no evidence of bacteriological failure of penicillins active against resistant strains. There is a single report of the failure of the less active agent, ticarcillin. High dose oral and intravenous amoxicillin should treat strains with MICs
There is increasing evidence of bacteriologically confirmed macrolide failure of pneumonia therapy at MICs
High dose, active ß-lactams or fluoroquinolones with enhanced activity against Gram positive pathogens remain the drugs of choice for the management of community-acquired pneumonia caused by the drug-resistant pneumococcus.
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