Penicillin-resistant pneumococcus and risk of treatment failure in pneumonia.
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.
Cardoso
Maria Regina A
MR
Faculdade de Saúde Pública, Universidade de São Paulo, Brazil. rcardoso@usp.br
Nascimento-Carvalho
Cristiana M
CM
Ferrero
Fernando
F
Berezin
Eitan N
EN
Ruvinsky
Raúl
R
Camargos
Paulo A M
PA
Sant'anna
Clemax C
CC
Brandileone
Maria Cristina C
MC
de Fátima P March
Maria
M
Feris-Iglesias
Jesus
J
Maggi
Ruben S
RS
Benguigui
Yehuda
Y
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
D000900:Anti-Bacterial Agents; D010406:Penicillins; D000667:Ampicillin