Pneumococcal infections medical therapy: Difference between revisions
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== Medical Therapy == | |||
Throughout history, treatment relied primarily on β-lactam antibiotics. In the 1960s, nearly all strains of ''S. pneumoniae'' were susceptible to [[penicillin]], but, since that time, there has been an increasing prevalence of penicillin [[antibiotic resistance|resistance]], especially in areas of high [[antibiotic]] use. A varying proportion of strains may also be resistant to [[cephalosporin]]s, [[macrolide]]s (such as erythromycin), [[tetracycline]], [[clindamycin]] and the [[quinolone]]s. Penicillin-resistant strains are more likely to be resistant to other antibiotics. Most isolates remain susceptible to [[vancomycin]], though its use in a β-lactam-susceptible isolate is less desirable because of tissue distribution of the drug and concerns of development of vancomycin resistance. More advanced beta-lactam antibiotics ([[cephalosporins]]) are commonly used in combination with other drugs to treat meningitis and community-acquired pneumonia. In adults, recently developed fluoroquinolones such as [[levofloxacin]] and [[moxifloxacin]] are often used to provide empiric coverage for patients with pneumonia, but, in parts of the world where these drugs are used to treat [[tuberculosis]], resistance has been described.<ref>{{cite doi|10.1016/S0140-6736(08)60350-5}}</ref> | |||
[[Susceptibility testing]] should be routine, with empiric antibiotic treatment guided by resistance patterns in the community in which the organism was acquired, pending the results. There is currently debate as to how relevant the results of susceptibility testing are to clinical outcome.<ref name="ClinInfectDis2006-Peterson">{{cite journal | author=Peterson LR | title=Penicillins for treatment of pneumococcal pneumonia: does in vitro resistance really matter? | journal=Clin Infect Dis | year=2006 | pages=224–33 | volume=42 | issue=2 | pmid=16355333 | doi=10.1086/497594}}</ref><ref name="ClinInfectDis2006-Tleyjeh">{{cite journal | author=Tleyjeh IM, Tlaygeh HM, Hejal R, Montori VM, Baddour LM | title=The impact of penicillin resistance on short-term mortality in hospitalized adults with pneumococcal pneumonia: a systematic review and meta-analysis | journal=Clin Infect Dis | year=2006 | pages=788–97 | volume=42 | issue=6 | pmid=16477555 | doi=10.1086/500140}}</ref> There is slight clinical evidence that penicillins may act synergistically with macrolides to improve outcomes.<ref>{{cite journal | title=Addition of a Macrolide to a β-Lactam based empirical antibiotic regimen is associated with lower in-hospital mortality for patients with bacteremic pneumococcal pneumonia | author=Martínez JA, Horcajada JP, Almela M, ''et al.'' | journal=Clin Infect Dis | volume=36 | year=2003 | pages=389–395 | doi=10.1086/367541 | pmid=12567294 | issue=4}}</ref> | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Needs | [[Category:Needs overview]] | ||
[[Category: | [[Category:Disease]] | ||
[[Category:Pneumonia]] | |||
[[Category:Bacterial diseases]] | |||
{{WH}} | |||
{{WS}} | |||
Latest revision as of 18:44, 18 September 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Medical Therapy
Throughout history, treatment relied primarily on β-lactam antibiotics. In the 1960s, nearly all strains of S. pneumoniae were susceptible to penicillin, but, since that time, there has been an increasing prevalence of penicillin resistance, especially in areas of high antibiotic use. A varying proportion of strains may also be resistant to cephalosporins, macrolides (such as erythromycin), tetracycline, clindamycin and the quinolones. Penicillin-resistant strains are more likely to be resistant to other antibiotics. Most isolates remain susceptible to vancomycin, though its use in a β-lactam-susceptible isolate is less desirable because of tissue distribution of the drug and concerns of development of vancomycin resistance. More advanced beta-lactam antibiotics (cephalosporins) are commonly used in combination with other drugs to treat meningitis and community-acquired pneumonia. In adults, recently developed fluoroquinolones such as levofloxacin and moxifloxacin are often used to provide empiric coverage for patients with pneumonia, but, in parts of the world where these drugs are used to treat tuberculosis, resistance has been described.[1] Susceptibility testing should be routine, with empiric antibiotic treatment guided by resistance patterns in the community in which the organism was acquired, pending the results. There is currently debate as to how relevant the results of susceptibility testing are to clinical outcome.[2][3] There is slight clinical evidence that penicillins may act synergistically with macrolides to improve outcomes.[4]
References
- ↑ Template:Cite doi
- ↑ Peterson LR (2006). "Penicillins for treatment of pneumococcal pneumonia: does in vitro resistance really matter?". Clin Infect Dis. 42 (2): 224&ndash, 33. doi:10.1086/497594. PMID 16355333.
- ↑ Tleyjeh IM, Tlaygeh HM, Hejal R, Montori VM, Baddour LM (2006). "The impact of penicillin resistance on short-term mortality in hospitalized adults with pneumococcal pneumonia: a systematic review and meta-analysis". Clin Infect Dis. 42 (6): 788&ndash, 97. doi:10.1086/500140. PMID 16477555.
- ↑ Martínez JA, Horcajada JP, Almela M; et al. (2003). "Addition of a Macrolide to a β-Lactam based empirical antibiotic regimen is associated with lower in-hospital mortality for patients with bacteremic pneumococcal pneumonia". Clin Infect Dis. 36 (4): 389–395. doi:10.1086/367541. PMID 12567294.