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Title: Pneumococcal antimicrobial resistance: Therapeutic strategy and management in community-acquired pneumonia
Authors: Aspa, Javier
Rajas, Olga
de Castro, Felipe Rodríguez 
Keywords: Level Fluoroquinolone Resistance
Combination Antibiotic-Therapy
Respiratory-Tract Infections
Beta-Lactam Antibiotics
In-Vitro Resistance
Macrolide Resistance
Issue Date: 2008
Publisher: 1465-6566
Journal: Expert Opinion on Pharmacotherapy 
Abstract: Streptococcus pneumoniae has been consistently shown to represent the most frequent causative agent of community-acquired pneumonia (CAP) and pneumococcal antibiotic resistance towards different families of antibiotics continues to be a much-debated issue. Microbial resistance causes a great deal of confusion in choosing an empirical treatment for pneumonia and this makes it necessary to know which factors actually determine the real impact of antimicrobial resistance on the outcome of pneumococcal infections. Several different aspects have to be taken into account when analyzing this matter, such as the study design, the condition of the patient at the time of diagnosis, the choice of the initial antimicrobial regimen (combination or monotherapy) and the pharmacokinetic/pharmacodynamic variables of the chosen antibiotic. It is generally accepted that in the treatment of beta-lactam-resistant pneumococcal infections, the use of standard antipneurnococcal beta-lactam agents is unlikely to impact negatively on the outcome of CAP when appropriate agents are given in sufficient doses. As a general rule, for infections with penicillin-sensitive strains, penicillin or an aminopenicillin in a standard dosage will be effective; in the cases of strains with intermediate resistance, beta-lactam agents are still considered appropriate treatment although higher dosages are recommended; finally, infections with isolates of high-level penicillin resistance should be treated with alternative agents such as the third-generation cephalosporins or the new antipneurnococcal fluoroquinolones. In areas of high prevalence of high-level macrolide resistance, empirical monotherapy with a macrolide is not optimal for the treatment of hospitalised patients with moderate or moderately-severe CAP. Fluoroquinolones are considered to be excellent antibiotics in the treatment of pneumococcal CAP in adults, but their general recommendation has been withheld due to fears of a widespread development of resistance. Most international guidelines recommend combination therapy (beta-lactam plus a macrolide) for the treatment of hospitalised patients with CAP.
ISSN: 1465-6566
DOI: 10.1517/14656566.9.2.229
Source: Expert Opinion on Pharmacotherapy[ISSN 1465-6566],v. 9, p. 229-241
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