Penicillin-resistant Streptococcus pneumoniae: selection by both β-lactam and non-β-lactam antibiotics

作者：F. W. Goldstein · 发表于：Journal of Antimicrobial Chemotherapy · 年份：1999 · DOI：10.1093/jac/44.2.141 · 被引用次数：52 · 研究领域：Pneumonia and Respiratory Infections、Pneumocystis jirovecii pneumonia detection and treatment、Antibiotic Use and Resistance

In recent years there has been a dramatic increase, worldwide, in the prevalence of so-called penicillin-resistant Streptococcus pneumoniae (PRSP);1 in some European countries and certain regions of the USA, South America and South East Asia, prevalences currently exceed 40–50%. The overall increase has been attributed to excessive global usage of antibiotics, particularly β -lactams, and, in an attempt to address this problem, it has been proposed that prescribing of these drugs should be reduced or avoided altogether. Clearly such an initiative is impractical in those clinical settings in which β-lactams are considered essential therapeutic agents. The more realistic strategy continues to be identification of those patients who require antibiotics and prescription of the most active compound at the optimal dosage for the optimal duration. Insofar as it is possible, the drug chosen should also have a low propensity for selecting resistant strains. PRSP strains may be selected either at the site of infection, where they may lead to clinical failure, or in the nasopharynx, from which they can be disseminated. Resistant strains may be present in the nasopharynx before therapy is initiated and subsequently selected by the antibiotic administered, or they may be acquired during therapy from another carrier, or they may be selected de novo by transformation or mutation. In theory, any antibiotic can select resistant strains, as long as the local concentration of the drug exceeds t...