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The incidence of antimicrobial-resistant strains of Streptococcus pneumoniae has increased alarmingly in recent years. The problem is exacerbated by the global spread of resistant organisms. Currently, the incidence of penicillin-resistant pneumococci isolated from clinical specimens in the United States is &gt; or = 35%. For empirical oral treatment of community-acquired respiratory infections, 3 choices are available: beta-lactam agents, macrolides, and fluoroquinolones. In considering the therapeutic efficacy of these agents, it is essential to also take pharmacokinetic and pharmacodynamic (PK/PD) factors into account. Many drugs are effective against penicillin-susceptible strains. However, the higher the minimum inhibitory concentration of penicillin, the more likely that cross-resistance to beta-lactam agents and macrolides will occur. Currently, the incidence of fluoroquinolone-resistant pneumococci is low; it is proposed that adequate dosing based on the PK/PD properties of fluoroquinolones may help reduce the emergence of resistant organisms. Prudent use of all antimicrobials is essential to decrease the emergence of strains resistant to these agents.

Microbiological and Pharmacodynamic Considerations in the Treatment of Infection Due to Antimicrobial-Resistant Streptococcus pneumoniae