Advances in Pneumococcal Antibiotic Resistance

Jae-Hoon Song


Expert Rev Resp Med. 2013;7(5):491-498. 

In This Article

Clinical Implications of Pneumococcal Resistance

According to the IDSA/ATS consensus guidelines on the management of CAP in adults, a macrolide is strongly recommended as a single regimen for outpatient treatment.[57] Considering increasing rates of resistance to macrolides in S. pneumoniae in some regions such as Asian countries, however, this recommendation should be used with caution. In fact, the IDSA/ATS guidelines suggest a 25% rate of high-level macrolide resistance as a threshold at which macrolides should no longer be used as empirical regimen for CAP.[57] Cefuroxime is recommended for patients with risk for antibiotic-resistant pneumococcal infection by the IDSA/ATS guidelines. However, it cannot be recommended in some regions with relatively high prevalence of cefuroxime resistance such as Asian countries. Fluoroquinolones are also recommended as an alternative therapy to treat patients with CAP in the United States and European guidelines.[57,71] Given a low prevalence of fluoroquinolone resistance in pneumococci in most areas, prudent use of fluoroquinolones based on correct diagnosis of CAP is acceptable.