Controversies in the Treatment of Pneumococcal Community-Acquired Pneumonia

Abstract

Community-acquired pneumonia remains an important cause of disease and death both in the developed and the developing worlds, despite the ready availability of potent antimicrobial agents to which the organisms remain susceptible. Furthermore, disease management is complicated by emerging resistance of the common pathogens to the various classes of commonly prescribed antimicrobial agents. Much recent research in the field of community-acquired pneumonia has focused attention on optimal treatment, evaluating the impact of antibiotic resistance, as well as of antimicrobial choices, on the outcome of these infections. In addition, efforts have been directed towards finding adjunctive therapies to antibiotics that may improve the prognosis of these patients. This article reviews some of these research areas, highlighting controversies that still exist with regard to final recommendations, and in particular with regard to infections with Streptococcus pneumoniae, the most common bacterial cause of community-acquired pneumonia.

New insights into pneumococcal disease

“…One particularly controversial issue is the impact of pneumococcal antibiotic resistance on the outcome of patients 1,59–61 . While much has been written on the topic of antimicrobial resistance, its prevalence, risk factors and mechanisms, until recently relatively few studies had been undertaken investigating its true impact on outcome 1,59–62 .…”

“…Streptococcus pneumoniae (pneumococcus) remains the commonest cause of pneumonia, meningitis and otitis media, and as such, infections with this microorganism are associated with significant morbidity and mortality worldwide. Treatment of these infections is complicated by the emergence of resistance of the pneumococcus to the various classes of antibiotics commonly used 1 . While much research has been devoted to an understanding of various aspects of pneumococcal disease, such as risk factors for infection, pathogenesis of the disease, assessment of severity of illness, impact of antimicrobial resistance and optimal antibiotic treatment, there still remains a number of unresolved issues and considerable ongoing controversies with regard to the management of these infections 1 .…”

“…Treatment of these infections is complicated by the emergence of resistance of the pneumococcus to the various classes of antibiotics commonly used 1 . While much research has been devoted to an understanding of various aspects of pneumococcal disease, such as risk factors for infection, pathogenesis of the disease, assessment of severity of illness, impact of antimicrobial resistance and optimal antibiotic treatment, there still remains a number of unresolved issues and considerable ongoing controversies with regard to the management of these infections 1 . This paper will explore some of these issues and describe new insights into pneumococcal infection that have arisen out of recent research.…”

Encouraging rational antibiotic use in childhood pneumonia: a focus on Vietnam and the Western Pacific Region

“…Although the correlation between in vitro and in vivo resistance remains contentious, it is generally assumed that penicillin (at adequate dosages) should still be effective against pneumococcal pneumonia (not meningitis) caused by strains with low or intermediate levels of resistance in vitro [13]. This is difficult to verify, as many factors that influence the outcome of pneumonia treatment-such as underlying comorbid conditions, disease severity and supportive treatment-are poorly described in historical datasets and adequately powered head-to-head comparisons are rare [14][15][16]. Another important factor to take into consideration is the roll-out of pneumococcal conjugate vaccines.…”

Cost-effectiveness of 13-valent pneumococcal conjugate vaccine in Switzerland

“…The transmission of pneumococcus requires direct contact with contaminated respiratory secretions between individuals 6 . However, the underlining treatment of the infections is often complicated due to resistance of the pathogen to several classes of antibiotics 7 .…”