title: Antibiotic management of pneumococcal infections in an era of increased resistance.
abstract: Pneumococci are a leading cause of bacterial meningitis and bacteraemia, as well as pneumonia, otitis media and sinusitis in childhood. These organisms recently have shown a dramatic increase in antibiotic resistance. Penicillin-resistant pneumococci are of special concern as they are often resistant to other unrelated antibiotics. This is of particular significance to Aboriginal children who have among the highest rates of pneumococcal infection in the world. Laboratories should now test all invasive pneumococcal isolates for penicillin and third generation cephalosporin resistance. Local treatment guidelines are required for pneumococcal infections, especially for meningitis, taking into account the prevalence of resistant strains within the community. At present, penicillin and amoxycillin remain the drugs of choice for pneumococcal infections, with the exception of meningitis where initial empirical therapy must be with a third generation cephalosporin. Judicious antibiotic use, which avoids over-prescribing and unnecessary use of broad-spectrum agents, improved living standards in underprivileged communities and introduction of an effective conjugate vaccine, able to reduce the rates of pneumococcal infection and hopefully colonization, may limit the spread of resistant strains.
authors.affiliation: Australasian Society for Infectious Diseases, Sydney, New South Wales, Australia.
authors.forename: K
authors.initials: K
authors.lastname: Grimwood
authors.forename: P J
authors.initials: PJ
authors.lastname: Collignon
authors.forename: B J
authors.initials: BJ
authors.lastname: Currie
authors.forename: M J
authors.initials: MJ
authors.lastname: Ferson
authors.forename: G L
authors.initials: GL
authors.lastname: Gilbert
authors.forename: G G
authors.initials: GG
authors.lastname: Hogg
authors.forename: D
authors.initials: D
authors.lastname: Isaacs
authors.forename: P B
authors.initials: PB
authors.lastname: McIntyre
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004352:Drug Resistance, Microbial; D018432:Drug Resistance, Multiple; D006801:Humans; D007223:Infant; D007769:Lactams; D008581:Meningitis / Q000188:drug therapy; D008826:Microbial Sensitivity Tests; D010033:Otitis Media / Q000188:drug therapy; D010403:Penicillin Resistance; D010406:Penicillins / Q000494:pharmacology / Q000627:therapeutic use; D011008:Pneumococcal Infections / Q000188:drug therapy* / Q000453:epidemiology; D011014:Pneumonia / Q000188:drug therapy; D015995:Prevalence; D011379:Prognosis; D013045:Species Specificity; D013296:Streptococcus pneumoniae / Q000187:drug effects*
chemical_list: D000900:Anti-Bacterial Agents; D007769:Lactams; D010406:Penicillins