Pneumococcal infection in children: rational antibiotic choice for drug-resistant Streptococcus pneumoniae.
Streptococcus pneumoniae is one of the most common bacterial causes of otitis media, sinusitis, bacteremia, pneumonia and bacterial meningitis in the pediatric population. The resistance of S. pneumoniae to penicillin and other antimicrobial agents is increasing in many parts of the world. In Taiwan, extremely high prevalence (70%) of penicillin-resistant S. pneumoniae among children with nasopharyngeal carriage has been reported. The mechanism of resistance to penicillin is the alteration of penicillin binding protein (PBP) instead of the production of beta-lactamase. Thus beta-lactamase inhibitors are not the solution to the treatment of infections caused by penicillin-resistant S. pneumoniae. The adequate treatment of infections caused by penicillin-resistant S. pneumoniae should be based on (1) site of infection (2) degree of resistance. Currently, the MIC breakpoints for S. pneumoniae are divided to 2 categories; one for CNS infection and the other for non-CNS infections. For non-CNS infections caused by susceptible or intermediate S. pneumoniae, penicillin still remains the drug of choice with excellent bactericidal activity. Vancomycin should not be the first choice in treating all pneumococcal infections.
Chiou
Christine C
CC
Department of Pediatrics, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung First Road, Kaohsiung, Taiwan.
Hseih
Kai-Sheng
KS
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002443:Ceftriaxone / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D006801:Humans; D007223:Infant; D008586:Meningitis, Pneumococcal / Q000188:drug therapy; D010033:Otitis Media / Q000188:drug therapy; D010403:Penicillin Resistance; D010406:Penicillins / Q000627:therapeutic use; D011008:Pneumococcal Infections / Q000188:drug therapy* / Q000382:microbiology; D011018:Pneumonia, Pneumococcal / Q000188:drug therapy; D013296:Streptococcus pneumoniae / Q000187:drug effects*; D013624:Taiwan
D000900:Anti-Bacterial Agents; D010406:Penicillins; D002443:Ceftriaxone