Macrolide-Resistant Streptococcus pneumoniae

Macrolide-Resistant Streptococcus pneumoniae

United States has one of highest rates of in-vitro macrolide resistance in developed world

Background

Streptococcus pneumoniae, also known as pneumococcus, is the most common cause of community-acquired pneumonia (CAP) and a common cause of otitis media (middle-ear infections) and bacterial meningitis. The bacterium strikes primarily pediatric populations and, to a lesser extent, elderly patients.

Because of increasing resistance to beta-lactam antibiotics (such as penicillin), macrolides such as clarithromycin have been used empirically to treat community-acquired respiratory tract infections (RTIs) since the early 1990s. Their use as first-line treatments for RTIs has in turn led to high rates of pneumococcus resistance to the drugs in the United States, especially when compared with other European nations. High rates of in vitro pneumococcal resistance may not necessarily correspond to adverse clinical outcomes. Nevertheless, guidelines recommend fluoroquinolones as an alternative therapy – a problematic solution, given the already overzealous use of these drugs.