title: Penicillin-resistant pneumococcus and risk of treatment failure in pneumonia.
abstract: OBJECTIVE
  To determine whether the presence of in vitro penicillin-resistant Streptococcus pneumoniae increases the risk of clinical failure in children hospitalised with severe pneumonia and treated with penicillin/ampicillin.
  
  
  METHODS
  Multicentre, prospective, observational study.
  
  
  METHODS
  12 tertiary-care centres in three countries in Latin America.
  
  
  METHODS
  240 children aged 3-59 months, hospitalised with severe pneumonia and known in vitro susceptibility of S pneumoniae.
  
  
  METHODS
  Patients were treated with intravenous penicillin/ampicillin after collection of blood and, when possible, pleural fluid for culture. The minimal inhibitory concentration (MIC) test was used to determine penicillin susceptibility of the pneumococcal strains isolated. Children were continuously monitored until discharge.
  
  
  METHODS
  The primary outcome was treatment failure (using clinical criteria).
  
  
  RESULTS
  Overall treatment failure was 21%. After allowing for different potential confounders, there was no evidence of association between treatment failure and in vitro resistance of S pneumoniae to penicillin according to the Clinical Laboratory Standards Institute (CLSI)/National Committee for Clinical Laboratory Standards (NCCLS) interpretative standards ((adj)RR = 1.03; 95%CI: 0.49-1.90 for resistant S pneumoniae).
  
  
  CONCLUSIONS
  Intravenous penicillin/ampicillin remains the drug of choice for treating penicillin-resistant pneumococcal pneumonia in areas where the MIC does not exceed 2 microg/ml.
authors.affiliation: Faculdade de Saúde Pública, Universidade de São Paulo, Brazil. rcardoso@usp.br
authors.forename: Maria Regina A
authors.initials: MR
authors.lastname: Cardoso
authors.forename: Cristiana M
authors.initials: CM
authors.lastname: Nascimento-Carvalho
authors.forename: Fernando
authors.initials: F
authors.lastname: Ferrero
authors.forename: Eitan N
authors.initials: EN
authors.lastname: Berezin
authors.forename: Raúl
authors.initials: R
authors.lastname: Ruvinsky
authors.forename: Paulo A M
authors.initials: PA
authors.lastname: Camargos
authors.forename: Clemax C
authors.initials: CC
authors.lastname: Sant'anna
authors.forename: Maria Cristina C
authors.initials: MC
authors.lastname: Brandileone
authors.forename: Maria
authors.initials: M
authors.lastname: de Fátima P March
authors.forename: Jesus
authors.initials: J
authors.lastname: Feris-Iglesias
authors.forename: Ruben S
authors.initials: RS
authors.lastname: Maggi
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Benguigui
mesh_terms: D000667:Ampicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001118:Argentina; D001938:Brazil; D002675:Child, Preschool; D004293:Dominican Republic; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010403:Penicillin Resistance; D010406:Penicillins / Q000627:therapeutic use*; D011018:Pneumonia, Pneumococcal / Q000188:drug therapy*; D011446:Prospective Studies; D017211:Treatment Failure
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins; D000667:Ampicillin