Emergence of Macrolide Resistance during Treatment of Pneumococcal Pneumonia

Abstract

Our fax numbers: 617-739-9864 and 617-734-4457Our e-mail address: letters@nejm.orgWe cannot acknowledge receipt of your letter, but we will notify you when we have made a decision about publication. We are unable to provide prepublication proofs. Financial associations or other possible conflicts of interest must be disclosed. Submission of a letter constitutes permission for the Massachusetts Medical Society, its licensees, and its assignees to use it in the Journal' s various print and electronic publications and in collections, revisions, and any other form or medium. 1 report that adjuvant chemotherapy with fluorouracil is as effective in older patients with resected colon cancer as it is in younger patients. Their conclusion is based on the absence of a statistically significant interaction between age and treatment effect for both overall and disease-free survival. However, the survival curves for treated and untreated patients who were more than 70 years old seem closer than the curves for treated and untreated younger patients. In our opinion, the absolute gain in survival is the measure that should be discussed with patients when deciding whether to use an adjuvant treatment. We suspect that the absolute differences in the study by Sargent et al. were small, and we would like to know what the absolute gain in survival was at each year of follow-up. 1. Nauta R, Stablein DM, Holyoke ED. Survival of patients with stage B2 colon carcinoma: the Gastrointestinal Tumor Study Group experience. Arch Surg 1989;124:180-2. 2. Gastrointestinal Tumor Study Group. Adjuvant therapy for colon cancerresults of a prospectively randomized trial. N Engl J Med 1984;310:737-43.To the Editor: Sargent et al. state that elderly persons receive adjuvant chemotherapy less frequently than younger patients, citing rates of chemotherapy use from a study that linked 1992 data from the Surveillance, Epidemiology, and End Results (SEER) Program with Medicare data for 1992. 1 However, two more recent studies of SEER-Medicare data report rates of use of adjuvant chemotherapy among elderly persons with stage III colon cancer that are considerably higher than the rates reported by Sargent et al. 2,3 With the use of data from 1992 to 1996, these studies showed that the rate of adjuvant-chemotherapy use wasThe New England Journal of Medicine Downloaded from nejm.org at STOCKHOLMS UNIVERSTITETSBIBL on August 10, 2015. For personal use only. No other uses without permission.

Canadian Guidelines for the Management of Acute Exacerbations of Chronic Bronchitis

“…Approximately 1% to 2% of macrolide-resistant isolates have neither the erm nor the mef gene. A new mechanism of macrolide resistance has been described with structural changes that conceivably may become more common in the future (250). Resistance trends and clinical significance: In the United States, resistance rates of pneumococci to the macrolides vary from 19% to 30% (225,251).…”

Molecular Epidemiology of Macrolide-Resistant Streptococcus pneumoniae Isolates in Europe

“…Other mechanisms of macrolide resistance have been described in only a few clinical isolates of S. pneumoniae. Changes were clustered in a highly conserved region of domain V of 23S rRNA, which plays a key role in macrolide binding (2,3,28,33), and in ribosomal proteins L4 and L22 (18,28).…”

Colonization of Streptococcus pneumoniae in Pneumonia Patients with Lung Cancer

“…S. pneumoniae, as one of the major etiological agents of pneumonia, was reported to have increased resistance towards various antibiotics such as cephalosporins, macrolides, penicillin, and fluoroquinolones (9,36). In the United States, S. pneumoniae resistance to penicillin ranged from 8% -15%, while in Asian countries it ranged from 50% to an overwhelming 70% (37)(38)(39). Streptococcus pneumoniae is reported to have an increased resistance towards penicillin while none of our isolates was found to be resistant to penicillin.…”