The Clinical Relevance of Antibiotic Resistance in the Management of Pneumococcal Pneumonia

Abstract

The incidence of antibiotic resistance is increasing in pneumococcal isolates worldwide. Current evidence suggests that the most active 13-lactam agents remain clinically useful in the treatment of penicillin-resistant pneumococcal pneumonia. These agents include intravenous penicillin, amoxicillin, cefuroxime, the third-generation cephalosporins cefotaxime and ceftriaxone, and the carbapenems. The authors recommend that penicillin or amoxicillin remain the drugs of choice for this condition. Macrolide resistance has been associated with clinical failure. The clinical relevance of resistance to trimethoprim/sulfamethoxazole has yet to be established. Most of the currently available quinolones are of borderline activity against the pneumococcus and would not be recommended for empiric therapy. Antibiotic-resistant pneumococci are increasingly found among HIV-infected patients. The therapeutic outcome appears, however, to be similar to that of patients without HIV infection.