Pneumococcal resistance: the treatment challenge.
OBJECTIVE
To review in vitro and in vivo information dealing with pneumococcal antibiotic resistance and provide a review of the incidence, mechanisms, and controversies surrounding this growing problem. The review is also intended to provide clinicians with relevant recommendations on treatment and prevention of this organism.


METHODS
Primary and review articles were identified by MEDLINE search (1966-August 2000) and through secondary resources such as conference proceedings. All of the articles identified from the data sources were evaluated, and all information deemed relevant was included in this review.


RESULTS
The growing incidence and reporting of pneumococcal isolates that are resistant to one or more classes of antibiotics have become a troubling trend that has resulted in significant shifts in treatment. Although clinicians have shifted to a new generation or class of antibiotics when faced with a resistance trend, data with resistant pneumococci show that this may not be necessary. By incorporating the pharmacokinetic and pharmacodynamic data of antimicrobials into the decision-making process, many of the drugs that we have become hesitant to use due to this resistance may still be appropriate if used correctly.


CONCLUSIONS
Appropriate dosing of antimicrobials, combined with optimal use of pneumococcal vaccines, will not only prolong the longevity of some agents, but also hopefully slow resistance development.
Amsden
G W
GW
Department of Pharmacy, Clinical Pharmacology Research Center, Bassett Healthcare, Cooperstown, NY 13326-1394, USA. guy.amsden@bassett.org
Amankwa
K
K
D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use; D004352:Drug Resistance, Microbial; D018432:Drug Resistance, Multiple; D024841:Fluoroquinolones; D006801:Humans; D018942:Macrolides; D011008:Pneumococcal Infections / Q000188:drug therapy* / Q000382:microbiology*; D013296:Streptococcus pneumoniae / Q000187:drug effects*; D018440:beta-Lactam Resistance
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D024841:Fluoroquinolones; D018942:Macrolides