Streptococcus pneumoniae drug-resistant

Dowell SF, Butler JC, Giebink GS, et al. Acute otitis media Management and surveillance in an era of pneumococcal resistance—A report from the Drug-resistant Streptococcus pneumoniae Therapeutic Working Group. Pediatr Infect Dis J 1999 18(l) l-9. 

Streptococcus pneumoniae is the most common bacterial cause of community-acquired respiratory tract infections. S. pneumoniae causes approximately 3000 cases of meningitis, 50,000 cases of bacteremia, 500,000 cases of pneumonia, and over 1 million cases of otitis media each year. The increasing prevalence of drug-resistant S. pneumoniae has highlighted the need to prevent infection through vaccination. Both licensed pneumococcal vaccines are highly effective in preventing disease from the common S. pneumoniae serotypes that cause human disease. 

Worldwide Streptococcus pneumoniae % susceptibility to penicillin is decreasing. In some countries up to two-thirds of the clinical isolates have reduced susceptibility to penicillin or are highly resistant to this drug. Moreover, the rate of resistance to other drugs commonly used for RTI including erythromycin, tetracycline and trimethoprim-sulfamethoxazole is higher in penicillin-resistant than penicillin-susceptible strains. Monitoring local or hospital resistance patterns of pneumococci is, therefore, needed. 

It is clinically important to understand the nature of the mechanism of resistance to an antibiotic drug. For example, the -lactam resistance of Streptococcus pneumoniae is due to the appearance of altered penicillinbinding proteins. Thus, the use of a combination of a 3-lactam and a penicillinase inhibitor, such as clavulanate, wUl not overcome streptococcal -lactam resistance, because the mechanism of resistance is not due to the production of a penicillinase. 

Appelbaum, PC., Resistance among Streptococcus pneumoniae implications for drug selection. Clin Infect Dis, 2002. 34(12) 1613-20. 

The need for new antibiotics is driven by the recent rise in the incidence of resistance to commonly used antibiotics. The emergence of multiple-drug resistance to community-acquired infections, such as those caused by Streptococcus pneumoniae, is particularly alarming due to the ease of transmission [1-4], Recent reports show that methicillin-resistant Staphylococcus aureus, the common cause of hospital-acquired infections, has also moved into the community [5],... 

Some streptococci have developed a different mechanism of acquired resistance to penicillin drugs. These bacteria have altered transpeptidases (also known as penicillin-binding proteins) that no longer bind penicillin, and thus peptidoglycan synthesis is not disrupted. This mechanism of resistance is found in Streptococcus pneumoniae. Estimates of penicillin-resistant S. pneumoniae in the United States range from 25% to 66%, including strains recovered from ocular and periocular infections. Many isolates of penicillin-resistant S.pneumoniae also are resistant to the cephalosporins, macrolides, and the older fluoroquinolones. Use of alternative antibiotics such as vancomycin is necessary for infections caused by penicillin-resistant isolates. 

Because of its potential toxicity, vancomycin is reserved for serious infections in which less toxic antibiotics are ineffective or not tolerated. Generally, vancomycin is administered intravenously because of poor intestinal absorption. It is the drug of choice for treating infections caused by methicillin-resistant staphylococci and penicillin-resistant Streptococcus pneumoniae. Vancomycin has been used to treat enterococcal infections because of their resistance to the P-lactam antibiotics, but most enterococci are now also resistant to vancomycin. Oral administration of rancomycin is important for treatment of some gastrointestinal infections such as pseudomembranous colitis caused by C. difficile. 

Avrain, L, Carvey M., Mesaros. N.. Clupczynski, Y, Mingeot-Leclercq. M.P., Piddock, L,J, Tulkens, P.M., Vanhoof, R., and Van Bambeke, F, (2007) Selection of qiunolone resistance in Streptococcus pneumoniae exposed in vitro to subinhibitory drug concentrations. The Journal of Antimicrobial Chemotherapy 60 (5), 965-972. 

Campbell GD, Silberman R. Drug-resistant Streptococcus pneumoniae. Clin Infect Dis 1998 26 1188-1195. 

Heffeltinger ID, Dowell SF, Jorgensen JH. Management of community-acquired pneumonia in the era of pneumococcal resistance A report from the Drug-Resistant Streptococcus pneumoniae Therapeutic Working Group. Arch Intern Med 2000 160 1399—1408. 

Anti-Inflammatory Therapeutics. The Streptococcus pneumoniae pulmonary host resistance assay is recommended for anti-inflammatory therapeutics (Komocsar et al., 2007). The Streptococcus pneumoniae pulmonary host resistance model in Lewis rats was used to assess the effects of anti-inflammatory agents on innate immunity. The model was able to predict potential drug suppression of the innate immune response to Streptococcus pneumoniae. The authors stated the ability to rank order the severity of innate immune suppression with multiple test articles in the same study made this model effective in screening potential drug candidates. 

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