title: Hidden epidemic of macrolide-resistant pneumococci.
abstract: Community-acquired respiratory tract infections (RTIs) account for a substantial proportion of outpatient antimicrobial drug prescriptions worldwide. Concern over the emergence of multidrug resistance in pneumococci has largely been focused on penicillin-resistant Streptococcus pneumoniae. Macrolide antimicrobial drugs have been widely used to empirically treat community-acquired RTIs because of their efficacy in treating both common and atypical respiratory pathogens, including S. pneumoniae. However, increased macrolide use has been associated with a global increase in pneumococcal resistance, which is leading to concern over the continued clinical efficacy of the macrolides to treat community-acquired RTIs. We provide an overview of macrolide-resistant S. pneumoniae and assess the impact of this resistance on the empiric treatment of community-acquired RTIs.
authors.affiliation: Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA. keith.klugman@emory.edu
authors.forename: Keith P
authors.initials: KP
authors.lastname: Klugman
authors.forename: John R
authors.initials: JR
authors.lastname: Lonks
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D004196:Disease Outbreaks; D024881:Drug Resistance, Bacterial; D006801:Humans; D018942:Macrolides / Q000494:pharmacology* / Q000627:therapeutic use; D011018:Pneumonia, Pneumococcal / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D012141:Respiratory Tract Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D013296:Streptococcus pneumoniae / Q000187:drug effects*
chemical_list: D000900:Anti-Bacterial Agents; D018942:Macrolides