title: Microbiological and pharmacodynamic considerations in the treatment of infection due to antimicrobial-resistant Streptococcus pneumoniae.
abstract: The incidence of antimicrobial-resistant strains of Streptococcus pneumoniae has increased alarmingly in recent years. The problem is exacerbated by the global spread of resistant organisms. Currently, the incidence of penicillin-resistant pneumococci isolated from clinical specimens in the United States is > or = 35%. For empirical oral treatment of community-acquired respiratory infections, 3 choices are available: beta-lactam agents, macrolides, and fluoroquinolones. In considering the therapeutic efficacy of these agents, it is essential to also take pharmacokinetic and pharmacodynamic (PK/PD) factors into account. Many drugs are effective against penicillin-susceptible strains. However, the higher the minimum inhibitory concentration of penicillin, the more likely that cross-resistance to beta-lactam agents and macrolides will occur. Currently, the incidence of fluoroquinolone-resistant pneumococci is low; it is proposed that adequate dosing based on the PK/PD properties of fluoroquinolones may help reduce the emergence of resistant organisms. Prudent use of all antimicrobials is essential to decrease the emergence of strains resistant to these agents.
authors.affiliation: Department of Pathology, Milton S. Hershey Medical Center, Hershey, PA 17033, USA. pappelbaum@psa.edu.
authors.forename: P C
authors.initials: PC
authors.lastname: Appelbaum
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000382:microbiology; D004352:Drug Resistance, Microbial; D024841:Fluoroquinolones; D006801:Humans; D007769:Lactams; D018942:Macrolides; D010403:Penicillin Resistance; D011008:Pneumococcal Infections / Q000188:drug therapy* / Q000382:microbiology*; D012141:Respiratory Tract Infections / Q000188:drug therapy / Q000382:microbiology; D013296:Streptococcus pneumoniae / Q000187:drug effects*
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D024841:Fluoroquinolones; D007769:Lactams; D018942:Macrolides