title: Antibacterial resistance among children with community-acquired respiratory tract infections (PROTEKT 1999-2000).
abstract: OBJECTIVE
  To determine the susceptibility of bacterial respiratory tract pathogens, isolated from children (0-12 years) as part of the global PROTEKT surveillance study (1999-2000), to a range of antibacterials, including the ketolide telithromycin.
  
  
  METHODS
  Minimum inhibitory concentrations of the antibacterials studied were determined at a central laboratory using the NCCLS microdilution broth method. Macrolide resistance mechanisms were detected by PCR.
  
  
  RESULTS
  Of 779 Streptococcus pneumoniae isolates worldwide, 43% were non-susceptible to penicillin (18% intermediate; 25% resistant) and 37% were resistant to erythromycin, with considerable intercountry variation. Eighteen per cent of 653 Haemophilus influenzae and >90% of 316 Moraxella catarrhalis isolates produced beta-lactamase. Of 640 Streptococcus pyogenes isolates, 10% were resistant to erythromycin, with considerable intercountry variation. All S. pneumoniae and 99.8% of H. influenzae isolates were susceptible to telithromycin using breakpoints proposed to the NCCLS (<or=1 and <or=4 mg/L, respectively). All M. catarrhalis and 97% of S. pyogenes and isolates were susceptible to <or=1 mg/L telithromycin.
  
  
  CONCLUSIONS
  Antibacterial resistance complicates the empirical treatment of respiratory tract infections in children and requires continued monitoring. Telithromycin may be a useful therapeutic alternative as it is highly active against strains exhibiting various resistance phenotypes.
authors.affiliation: GR Micro Ltd, London, UK. d.felmingham@grmicro.co.uk
authors.forename: D
authors.initials: D
authors.lastname: Felmingham
authors.forename: D J
authors.initials: DJ
authors.lastname: Farrell
authors.forename: R R
authors.initials: RR
authors.lastname: Reinert
authors.forename: I
authors.initials: I
authors.lastname: Morrissey
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology / Q000235:genetics / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D018432:Drug Resistance, Multiple; D005260:Female; D014943:Global Health; D006801:Humans; D048628:Ketolides; D018942:Macrolides / Q000627:therapeutic use; D008297:Male; D008826:Microbial Sensitivity Tests; D016133:Polymerase Chain Reaction; D011159:Population Surveillance; D012141:Respiratory Tract Infections / Q000188:drug therapy / Q000453:epidemiology / Q000235:genetics / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents; D048628:Ketolides; D018942:Macrolides; C106791:telithromycin