The rate of drug resistant bacteria is
dramatically increasing.2 |
| Proportion of S. pneumoniae isolates not susceptible to penicillin or cefotaxime, identified by national surveillance from the CDC. |
 |
| Over the past 5 years, the rate of penicillin resistance increased by more than 300% and the rate of cefotaxime resistance increased by more than 1000%. |
Some pneumococci are resistant to all oral
antibiotic agents. |
| Pneumococci have developed resistance to cephalosporins, erythromycin, trimethoprim-sulfamethoxazole, quinolones, and other agents. The only remaining antibiotic that is effective against all pneumococci is vancomycin. |
| Increasing antibiotic use is a likely cause. |
| Antimicrobial prescription rate in children by officebased physicians, 1980-1992 |
 |
| A national office-based study suggested an increase of 48% in antibiotic prescribing for children.3 |
|
Antibiotics foster resistance in individual
patients . . . In cases where they are not
necessary, is it worth the risk? |
| Antimicrobial prophylaxis and carriage of penicillin-resistant pathogens4 |
|
| Even prophylactic doses cause resistant organisms to proliferate. |
| Does antibiotic resistance put patients at risk for adverse clinical outcomes? |
Seven studies have identified recent antibiotic
use as a risk factor for invasive disease with
nonsusceptible pneumococci.5
Otitis media with penicillin non-susceptible strains has an increased risk of bacteriologic and clinical treatment failure, even with commonly used cephalosporins.6
Experts now suggest vancomycin for empiric treatment of meningitis and other life threatening infections, to cover for penicillin resistance. |
References |
| 1. |
Dowell SF, Marcy SM, Phillips WR, Gerber MA, Schwartz B. Principles of judicious use of antimicrobial agents for pediatric upper respiratory tract infections. Pediatrics 1998;101:163-165. |
| 2. |
Butler JC, Hofmann J, et al. The continued emergence of drugresistant Streptococcus pneumoniae in the United States: an update from the CDC’s Pneumococcal Sentinel Surveillance System. J Infect Dis 1996; 174:986-93. |
| 3. |
McCaig L, Hughes J. Trends in antimicrobial drug prescribing among office-based physicians in the United States. JAMA 1995; 273:214- 219. |
| 4. |
Brook I, Gober AE. Prophalaxis with amoxicillin or sulfisoxazole for OM: effect on the recovery of penicillin-resistant bacteria from children. Clin Infect Dis 1996;42:353-56. |
| 5. |
Dowell SF, Schwartz B. Resistant pneumococci: Protecting patients through judicious antibiotic use. Am Fam Physician 1997;55:1647- 54. |
| 6. |
Dagan R, Abramson O et al. Impaired bacteriologic response to oral cephalosporins in acute otitis media caused by pneumococci with intermediate resistance to penicillin. Pediatr Infect Dis J. 1996;15:980-85. |
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