title: Ciprofloxacin treatment failure in a patient with resistant Streptococcus pneumoniae infection following prior ciprofloxacin therapy.
abstract: Reported here is the case of a patient with underlying chronic obstructive pulmonary disease (COPD) in whom ciprofloxacin treatment of a lower respiratory tract infection failed subsequent to ciprofloxacin treatment of an exacerbation of COPD several weeks earlier. During the second course of ciprofloxacin therapy, the patient's condition continued to deteriorate, and she was admitted to the intensive care unit. Bilateral pneumonia was diagnosed. Streptococcus pneumoniae, serotype 11A, resistant to ciprofloxacin was isolated from the sputum. Sequencing revealed a S79F mutation in parC and there was evidence of an efflux pump. The patient improved rapidly after administration of azithromycin and ampicillin/sulbactam. This report of treatment failure due to ciprofloxacin-resistant Streptococcus pneumoniae shows that fluoroquinolones should be avoided when treating patients who have recently received this class of antibiotics.
authors.affiliation: Department of International Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA. mpletz@sph.emory.edu
authors.forename: M W R
authors.initials: MW
authors.lastname: Pletz
authors.forename: L
authors.initials: L
authors.lastname: McGee
authors.forename: O
authors.initials: O
authors.lastname: Burkhardt
authors.forename: H
authors.initials: H
authors.lastname: Lode
authors.forename: K P
authors.initials: KP
authors.lastname: Klugman
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D002939:Ciprofloxacin / Q000494:pharmacology / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008826:Microbial Sensitivity Tests; D011018:Pneumonia, Pneumococcal / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D013296:Streptococcus pneumoniae / Q000302:isolation & purification*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin