The Value of Macrolide-Based Regimens for Community-Acquired Pneumonia

McFarlane, Alexandra; Sligl, Wendy

doi:10.1007/s11908-015-0507-4

Cited by 8 publications

(6 citation statements)

References 85 publications

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“…The erm (B) gene-mediated resistance in pneumococci gives high-level resistance (MLS B phenotype), with MIC values typically ≥ 64 μg/mL. In contrast, the efflux pump (M phenotype) encoded by the mef (A) gene confers a low-level resistance, with MIC usually 1 μg/mL–32 μg/mL ( 9 , 17 , 18 ). Similarly, in this study, among the 30 erythromycin-resistant pneumococci, isolates that carry the erm (B) gene alone or both erm (B) and mef (A) genes showed higher MICs, ranging from 2 μg/mL to > 256 μg/mL, with MIC 90 values for erm (B) gene being > 256 μg/mL.…”

Section: Discussionmentioning

confidence: 99%

Detection of Macrolide-Resistant Streptococcus pneumoniae Genes and Its Clinical Outcomes in a Tertiary Teaching Hospital in Malaysia

Wan Mahmud,

Hassan,

Abd Rahman

et al. 2024

MJMS

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Background: Streptococcus pneumoniae is one of the leading causes of mortality and morbidity worldwide. The dramatic increase in in-vitro resistance of antimicrobial agents, particularly beta-lactams and macrolides, makes pneumococcal infections difficult to treat. The aim of this study was to describe the drug resistance rate, assess the prevalence of macrolideresistant genes and review the clinical complications of pneumococcal infections among patients presented to Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia. Methods: This is a descriptive cross-sectional study. All S. pneumoniae isolates collected from clinical specimens within a 1-year period were subjected to selected antimicrobial susceptibility testing using E-test strips. Polymerase chain reaction (PCR) analysis was conducted to detect macrolide-resistant determinants. The patient’s clinical data were obtained from clinical notes. Results: A total of 113 patients with a positive growth of S. pneumoniae were included in the study. The most common predisposing factors among them were bronchopulmonary diseases (15.9%). The penicillin-resistant rate was 7.1%, with minimal inhibitory concentration (MIC) ranging between 0.012 µg/mL and >32 µg/mL, and the erythromycin-resistant rate was 26.5%, with a MIC range of 0.03 µg/mL–> 256 µg/mL. Most of the erythromycin-resistant isolates were found to have the mef(A) gene (50.4%) and the erm(B) gene (20%); 16.7% had a combination of genes mef(A) and erm(B), and 13.3% had none of the two genes. Community-acquired pneumonia is the predominant type of pneumococcal infection. There was no significant association between the presence of macrolide resistance determinants and mortality (P = 0.837) or complications (P > 0.999 for empyema and cardiac complication; P = 0.135 for subdural abscess). Conclusion: The majority of erythromycin-resistant isolates were found to have the mef(A) gene, followed by the erm(B) gene and a combination of genes mef(A) and erm(B).

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Section: Discussionmentioning

confidence: 99%

Detection of Macrolide-Resistant Streptococcus pneumoniae Genes and Its Clinical Outcomes in a Tertiary Teaching Hospital in Malaysia

Wan Mahmud,

Hassan,

Abd Rahman

et al. 2024

MJMS

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“…Education on the use of narrow-spectrum antibiotics could be considered for campaigns to improve the choice of antibiotic. Macrolides remain commonly prescribed for the treatment of RTIs, but the development of widespread macrolide resistance has limited their use [ 19 ]. In addition, macrolide resistance persists much longer compared to amoxicillin resistance, which is another reason to encourage amoxicillin prescribing, if prescribing is indicated [ 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

Disease-Specific Quality Indicators for Outpatient Antibiotic Prescribing for Respiratory Infections (ESAC Quality Indicators) Applied to Point Prevalence Audit Surveys in General Practices in 13 European Countries

et al. 2023

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Up to 80% of antibiotics are prescribed in the community. An assessment of prescribing by indication will help to identify areas where improvement can be made. A point prevalence audit study (PPAS) of consecutive respiratory tract infection (RTI) consultations in general practices in 13 European countries was conducted in January–February 2020 (PPAS-1) and again in 2022 (PPAS-4). The European Surveillance of Antibiotic Consumption quality indicators (ESAC-QI) were calculated to identify where improvements can be made. A total of 3618 consultations were recorded for PPAS-1 and 2655 in PPAS-4. Bacterial aetiology was suspected in 26% (PPAS-1) and 12% (PPAS-4), and an antibiotic was prescribed in 30% (PPAS-1) and 16% (PPAS-4) of consultations. The percentage of adult patients with bronchitis who receive an antibiotic should, according to the ESAC-QI, not exceed 30%, which was not met by participating practices in any country except Denmark and Spain. For patients (≥1) with acute upper RTI, less than 20% should be prescribed an antibiotic, which was achieved by general practices in most countries, except Ireland (both PPAS), Croatia (PPAS-1), and Greece (PPAS-4) where prescribing for acute or chronic sinusitis (0–20%) was also exceeded. For pneumonia in adults, prescribing is acceptable for 90–100%, and this is lower in most countries. Prescribing for tonsillitis (≥1) exceeded the ESAC-QI (0–20%) in all countries and was 69% (PPAS-1) and 75% (PPAS-4). In conclusion, ESAC-QI applied to PPAS outcomes allows us to evaluate appropriate antibiotic prescribing by indication and benchmark general practices and countries.

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“…Macrolide antimicrobials are commonly prescribed agents for the management of respiratory tract infections [7]. As a class, macrolides are bacteriostatic and function by inhibiting bacterial protein synthesis through reversible binding to 23S ribosomal RNA of the 50S ribosomal subunit, resulting in inhibition of RNA-dependent protein synthesis [8].…”

Section: Mechanism Of Actionmentioning

confidence: 99%

Moving Past the Routine Use of Macrolides—Reviewing the Role of Combination Therapy in Community-Acquired Pneumonia

Shumilak

Sligl

2018

Curr Infect Dis Rep

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Recent randomized controlled trials have assessed the non-inferiority of beta-lactam monotherapy compared to beta-lactam/macrolide combination therapy in adult patients hospitalized with CAP. Beta-lactam monotherapy was associated with equivalent clinical outcomes in patients with mild to moderate CAP. Patients with severe CAP managed with beta-lactam monotherapy have demonstrated worse clinical outcomes when compared to patients treated with combination therapy. In addition, previous beta-lactam exposure prior to hospitalization has not been shown to negatively impact outcomes in patients managed with beta-lactam monotherapy in the hospital. Current evidence supports the use of beta-lactam monotherapy in adult patients hospitalized with mild to moderate CAP. While existing evidence supports the use of combination therapy in patients with severe pneumonia, further large-scale randomized controlled trials are urgently needed to clarify the role of combination therapy in this population.

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The Value of Macrolide-Based Regimens for Community-Acquired Pneumonia

Cited by 8 publications

References 85 publications

Detection of Macrolide-Resistant Streptococcus pneumoniae Genes and Its Clinical Outcomes in a Tertiary Teaching Hospital in Malaysia

Detection of Macrolide-Resistant Streptococcus pneumoniae Genes and Its Clinical Outcomes in a Tertiary Teaching Hospital in Malaysia

Disease-Specific Quality Indicators for Outpatient Antibiotic Prescribing for Respiratory Infections (ESAC Quality Indicators) Applied to Point Prevalence Audit Surveys in General Practices in 13 European Countries

Moving Past the Routine Use of Macrolides—Reviewing the Role of Combination Therapy in Community-Acquired Pneumonia

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