4 VIEWS &: REVIEWS

Minimising penicillin resistance in pneumococcal infections

When a ~-lactam antibacterial is chosen for treating respiratory tract infections (RTIs), the selection 'should be made on the basis of minimal resistance potential activity' against Streptococcus pneumoniae and the ability of the drug to penetrate respiratory secretions, says Dr Burke A Cunha from New York, US.

Currently, penicillin resistance does not appear to be absolute among pneumococci, and highly-resistant S. pneumoniae strains are rare. However, relatively resistant strains are increasing (as indicated by trends in minimum inhibitory concentrations), indicating a potential problem that may still be curbed.

Thus, strategies need to be used that minimise the general increase in resistance of ~-lactams to S. pneumoniae, e.g. by choosing an antibacterial known to have a high degree of anti pneumococcal activity with a low resistance potential, explains Dr Cunha Examples of such agents include doxycycline, cefprozil, levofloxacin, cefepime and meropenem.

Limit vancomycin use If macrolides are to be used for RTIs, clarithromycin

or azithromycin can be recommended, while erythromycin does not penetrate well into respiratory secretions, comments Dr Cunha.

Vancomycin is useful to treat highly resistant strains but its use should be limited to try and minimise the emergence of vancomycin-resistant pathogens and S. aureus strains with intermediate vancomycin sensitivity.

Antibacterials should not be used to treat virall allergic diseases or foreign body infections where removal is required for cure, nor should they be used in place of surgical drainage for obstruction or abscess, stresses Dr Cunha. Cunha BA. Penicillin-resistant pneumococci. Drugs of Today 34: 31-35, Jan 1998

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