Hidden Epidemic of Macrolide-resistant Pneumococci

Abstract

Community-acquired respiratory tract infections (RTIs) account for a substantial proportion of outpatient antimicrobial drug prescriptions worldwide. Concern over the emergence of multidrug resistance in pneumococci has largely been focused on penicillin-resistant Streptococcus pneumoniae. Macrolide antimicrobial drugs have been widely used to empirically treat community-acquired RTIs because of their efficacy in treating both common and atypical respiratory pathogens, including S. pneumoniae. However, increased macrolide use has been associated with a global increase in pneumococcal resistance, which is leading to concern over the continued clinical efficacy of the macrolides to treat community-acquired RTIs. We provide an overview of macrolide-resistant S. pneumoniae and assess the impact of this resistance on the empiric treatment of community-acquired RTIs.

Prevalence and Antibacterial Susceptibility of mef (A)-Positive Macrolide-Resistant Streptococcus pneumoniae over 4 Years (2000 to 2004) of the PROTEKT US Study

“…Pneumococcal macrolide resistance is of increasing concern in the clinical setting (8). In recent years, a number of reports have been published linking occurrences of macrolide treatment failure (sometimes resulting in hospitalization with breakthrough bacteremia) with infection by macrolide-resistant strains of S. pneumoniae in patients with community-acquired RTIs.…”

Serotype and Genotype Replacement among Macrolide-Resistant Invasive Pneumococci in Adults: Mechanisms of Resistance and Association with Different Transposons

“…The worldwide increase in the prevalence of macrolide resistance (MR) in Streptococcus pneumoniae is a matter for concern, because of the risk of treatment failure in infections caused by these microorganisms (16). A global international surveillance project (PROTEKT, 2003(PROTEKT, to 2004 found that the overall rate of erythromycin resistance was 37.2%, although significant geographical differences in these rates were observed (11).…”

Concerning the Diagnostic and Treatment Problems of Children with Pneumonia

“…Собственные данные о высокой частоте назначения больным с типичной пневмонией макролидов в качестве стартового препарата, неэффективность которых при данной форме отмечена многими авторами [22][23][24], совпадают с наблюдениями в Москве (у 33% детей) и Казани (у 21%) [7,20].…”