Management of Community-Acquired Pneumonia in the Era of Pneumococcal Resistance

Abstract

When implicated in cases of pneumonia, S pneumoniae should be considered susceptible if penicillin minimum inhibitory concentration (MIC) is no greater than 1 microg/mL, of intermediate susceptibility if MIC is 2 microg/ mL, and resistant if MIC is no less than 4 microg/mL. For outpatient treatment of community-acquired pneumonia, suitable empirical oral antimicrobial agents include a macrolide (eg, erythromycin, clarithromycin, azithromycin), doxycycline (or tetracycline) for children aged 8 years or older, or an oral beta-lactam with good activity against pneumococci (eg, cefuroxime axetil, amoxicillin, or a combination of amoxicillin and clavulanate potassium). Suitable empirical antimicrobial regimens for inpatient pneumonia include an intravenous beta-lactam, such as cefuroxime, ceftriaxone sodium, cefotaxime sodium, or a combination of ampicillin sodium and sulbactam sodium plus a macrolide. New fluoroquinolones with improved activity against S pneumoniae can also be used to treat adults with community-acquired pneumonia. To limit the emergence of fluoroquinolone-resistant strains, the new fluoroquinolones should be limited to adults (1) for whom one of the above regimens has already failed, (2) who are allergic to alternative agents, or (3) who have a documented infection with highly drug-resistant pneumococci (eg, penicillin MIC > or =4 microg/mL). Vancomycin hydrochloride is not routinely indicated for the treatment of community-acquired pneumonia or pneumonia caused by DRSP.

Prevalência de sorotipos e resistência antimicrobiana de cepas invasivas do Streptococcus pneumoniae

“…30 For invasive strains, with the exception of those obtained from patients with meningitis, the proposed values are a MIC < 1.0 µg/ml for susceptibility, 2.0 µg/ml for intermediate resistance and > 4.0 µg/ml for total resistance. By these new classifications, only three strains of pneumococcus, obtained from pneumonia patients, would be classed as intermediately resistant (MIC = 2.0 µg/ml) and none as totally so.…”

Diagnóstico etiológico das pneumonias: uma visão crítica

“…Considera-se que cepas com MIC < 0,06 µg/ml são sensí-veis, cepas com MIC entre 0,1 e 1 µg/ml são relativamente resistentes ou de resistência intermediária, e cepas com MIC > 2 µg/ml são de alta resistência 100 . Recentemente, essa classificação foi revista por alguns autores, que consideram, para as pneumonias pneumocócicas, limites superiores para cepas sensíveis, de suscetibilidade intermediária e resistentes, respectivamente, até 1 µg/mL, de 1 a 2µg/l e maior que 4 µg/ml 101 . Essas cepas podem ser resistentes a outros antimicrobianos (cefalosporinas, cloranfenicol, eritromicina, clindamicina e sulfametoxazol-trimetroprima), caracterizando uma situação de multirresistência 100 .…”

Effectiveness of oral moxifloxacin in standard first-line therapy in community-acquired pneumonia

“…Several new approaches to the management of CAP have been published, including those of the Infectious Diseases Society of America [10], the Canadian Infectious Disease Society-Canadian Thoracic Society [11], the European Respiratory Society [12], the Drug-Resistant Streptococcus pneumoniae Therapeutic Working Group [13] and the American Thoracic Society (ATS) [14].…”