FILE TM; Interscience Conference on Antimicrobial Agents and Chemotherapy.
Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 2000 Sep 17-20; 40: 522.
Northeastern Ohio Univ. Coll. of Med., Akron, OH
The emergence of DRSP has complicated and influenced the choice of therapy for CAP. While there is evidence that DRSP affects the outcome for meningitis or otitis, the relevance for CAP has been controversial.Much of the controversy for penicillin (pcn) and other beta-lactams relates to interpretation of the breakpoint for resistance. Numerous studies suggest there is no difference in mortality of CAP (controlled for known mortality risk factors) if caused by isolates with MIC < 2 ug/ml. Recent studies suggest that pcn resistance may be associated with risk of suppurative complications (Metlay et al., 00) or increased mortality if MIC >/=2 ug/ml (Turret et al, 99), or >2 ug/ml (Feikin et al, 00); however, there is not sufficient data to evaluate the effect of concordant/discordant therapy. PK/PD data support that pcn and other beta-lactams should be effective against strains with MIC up to 2 ug/ml. While macrolide resistance is increasing, there are until recently few reports of clinical failure in patients without risk factors for DRSP. This may be due to the type of resistance (mef vs erm); it is possible that mef associated resistance may be overcome by achievable levels of the newer macrolides. With increasing use there is concern for reduced efficacy of macrolides. The new fluoroquinolones (FQ) are effective for PRSP but recent reports have described emergence of some resistance which may have been driven by the use of the older FQ. Recent guidelines address the issue of DRSP and stratify patients on a variety of risk factors (3rd Gen Ceph + macrolide; or new FQ are variably recommended for empirical therapy of CAP requiring admission to general wards). Directed therapy for DRSP should be based on the MIC. New agents are available but judicious use of antibiotics is urged.KEYWORDS: Outcomes; Pneumococcus; Resistance
Publication Types:
Keywords:
- Anti-Bacterial Agents
- Fluoroquinolones
- Humans
- Macrolides
- Microbial Sensitivity Tests
- Penicillins
- Physical Examination
- Pneumonia
- Pneumonia, Bacterial
- Pneumonia, Pneumococcal
- Streptococcus pneumoniae
- beta-Lactams
- methods
- psychology
- therapy
Other ID:
UI: 102247515
From Meeting Abstracts