Chapter 20 : Clinical Relevance of Antibiotic Resistance in Pneumococcal Infections

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The clinical relevance of antibiotic resistance in the treatment of pneumococcal pneumonia has recently been reviewed. This chapter updates the review and expands it to the consideration of other pneumococcal diseases such as meningitis, otitis media, sinusitis, exacerbations of chronic bronchitis, and the limited literature on other types of infection such as infections of the pleura and endocarditis. Pharmacodynamics predict that high doses of intravenous penicillin remain useful for the treatment of pneumococcal pneumonia up to MICs of 4 μg/ml. Bacteremic pneumonia caused by a resistant strain has been described following trimethoprim-sulfamethoxazole therapy in a child and an adult and following prophylaxis with this agent, suggesting that the MICs of the agent for resistant strains probably exceed the levels achievable by oral dosing. Double-tympanocentesis studies have clearly demonstrated the relevance of pharmacodynamic principles for the prediction of bacterial eradication from the middle ear. As antimicrobial penetration into the cerebrospinal fluid is limited by the blood-brain barrier, lower levels of resistance are associated with clinical failure, which has been shown to occur even with intermediately beta-lactam-resistant strains. Pharmacodynamic principles explain the clinical failures observed with the emergence of resistance in some classes of antibiotics and also explain the successful continued use of the more active drugs despite the emergence of resistance. They thus allow the development of rational guidelines for the treatment of infections caused by antibiotic-resistant pneumococci.

Citation: Klugman K. 2004. Clinical Relevance of Antibiotic Resistance in Pneumococcal Infections, p 331-338. In Tuomanen E, Mitchell T, Morrison D, Spratt B (ed), The Pneumococcus. ASM Press, Washington, DC. doi: 10.1128/9781555816537.ch20

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Acute Otitis Media
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Pharmacodynamic breakpoints above which antibiotics used to treat infections outside of the meninges are predicted to fail

Citation: Klugman K. 2004. Clinical Relevance of Antibiotic Resistance in Pneumococcal Infections, p 331-338. In Tuomanen E, Mitchell T, Morrison D, Spratt B (ed), The Pneumococcus. ASM Press, Washington, DC. doi: 10.1128/9781555816537.ch20

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