Prevention and management of antibacterial resistance for primary care patients with respiratory tract infections.
This review examines the problem of increasing antibacterial resistance among the pathogens commonly associated with community-acquired respiratory tract infections, particularly Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. The increases in morbidity, mortality, and treatment cost associated with increased resistance to available antibiotics are challenging prescribers to find more effective therapeutic strategies. A MEDLINE search of the literature from 1966 to the present was performed to seek data relevant to the issue of resistance, especially the negative effects on patient outcomes and costs of therapy. Several observations and conclusions emerged. Data are lacking on local resistance patterns, broad-spectrum agents are overprescribed when narrower-spectrum choices would be more appropriate, a need exists for educational programs to encourage restricting drug use and changing prescribing habits, and there is a need for new antibiotic choices. The best antibiotic options are agents with a tailored spectrum of activity that are targeted at particular respiratory tract pathogens and have low potential to select for resistant organisms.
Department of Medicine, Danbury Hospital, Danbury, CT 06810, USA. paul.iannini@danhosp.org
Paul
P
Iannini
D024881:Drug Resistance, Bacterial; D006193:Haemophilus influenzae / Q000187:drug effects* / Q000472:pathogenicity; D006801:Humans; D001936:Moraxella catarrhalis / Q000187:drug effects* / Q000472:pathogenicity; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D012141:Respiratory Tract Infections / Q000382:microbiology* / Q000517:prevention & control*; D013296:Streptococcus pneumoniae / Q000187:drug effects* / Q000472:pathogenicity