title: Azithromycin treatment failure in community-acquired pneumonia caused by Streptococcus pneumoniae resistant to macrolides by a 23S rRNA mutation.
abstract: In this report, we describe an azithromycin treatment failure in community-acquired pneumonia. During the first three days of azithromycin, the patient's symptoms worsened, and she was subsequently admitted to the hospital. Blood cultures were positive for a penicillin-susceptible, macrolide-resistant S. pneumoniae. DNA sequencing revealed an A2059G mutation in domain V of the 23S rRNA. To our knowledge, this is the first clinical report of an azithromycin failure in the treatment of S. pneumoniae resistant to macrolides by this mechanism.
authors.affiliation: Department of Pharmacy Practice, Purdue University School of Pharmacy and Pharmacal Sciences, Indianapolis, IN 46202, USA. mkays@iupui.edu
authors.forename: Michael B
authors.initials: MB
authors.lastname: Kays
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Wack
authors.forename: David W
authors.initials: DW
authors.lastname: Smith
authors.forename: Gerald A
authors.initials: GA
authors.lastname: Denys
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D017963:Azithromycin / Q000494:pharmacology* / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000188:drug therapy*; D024881:Drug Resistance, Bacterial / Q000235:genetics*; D005260:Female; D014644:Genetic Variation / Q000235:genetics; D006801:Humans; D008875:Middle Aged; D011014:Pneumonia / Q000188:drug therapy*; D012338:RNA, Ribosomal, 23S / Q000235:genetics; D017422:Sequence Analysis, DNA; D013296:Streptococcus pneumoniae / Q000187:drug effects* / Q000235:genetics*; D017211:Treatment Failure
chemical_list: D000900:Anti-Bacterial Agents; D012338:RNA, Ribosomal, 23S; D017963:Azithromycin