Streptococcus tshz), which form

We found that the level of penicillin resistance among S. pneumonia

isolates six times higher than in 1989

in one other great Australian multicenter study

but, fortunately, was still below

, than in most other countries. Penicillin resistance rates

very high in the developing world, and in some parts of West

Europe and the USA. However, the growth rate of resistance in Australia looks very

similar to that observed in the early 1980s in countries such as Spain

there, only

0. 02% of strains were resistant to penicillin nationally in the early 1980's >> << and still only 1. 3% in 1992

but a recent study found in 25%, with much higher rates in some >> << subgroups (eg, 40% of white children). The same concern was that

, 3% of strains were high levels of resistance to penicillin and cephalosporins as

third generation. Over the next few years we will probably see similar figures

resistance developing in Australia. Finding high levels of resistance to penicillin among S. pneumonia

isolates in Australia is of particular concern in

meningitis caused by organisms with any level of resistance to penicillin

, penicillin treatment may fail. Penicillin resistance has

implications for other drug-related, and

S. pneumonia lactamase production (as in Staphylococcus aureus), but changes in the

-target for penicillin (penicillin -binding proteins). -Lactams, including

third-generation cephalosporins. However, the level of third-generation cephalosporins >> << achieved in CSF

still high enough to eradicate organisms with intermediate resistance to penicillin

. Alternative schemes include combination therapy with

vancomycin, third generation cephalosporins and rifampicin, and >> << and new tools such as meropenem, teicoplanin and quinolones

(the investigation)

and no one had properly appreciated. Even more worrying is the rapid growth of resistance to cephalosporins >> << noted the third generation in the United States

. Primary resistance to these drugs is less common than

penicillin, but requires fewer genetic changes. In some areas up to 27%

resistant to penicillin pneumococci with high level resistance to cefotaxime

. This leads to therapeutic failure

these drugs, but they are the main treatment more >> << intermediate penicillin-resistant strains.

No high level cefotaxime-resistant strains were observed in our study

or were registered in Australia, to our knowledge. However, given the

global spread of resistant pneumococci in the recent past >> << they inevitably will be seen soon in Australia and leave us with

main therapeutic dilemmas in the treatment of meningitis. In life threatening situations, other than meningitis (eg

bacteremia), high dose intravenous penicillin is sufficient >> << eradicate organisms with intermediate resistance, as drug levels

achievable in serum, still much higher than the MIC. There is, however,

. disputes, and many recommend the use of ceftriaxone or cefotaxime or

For organisms with high levels of resistance, the most appropriate agent

unclear. However, we stand vancomycin. In not life-threatening infections resistant to penicillin

pneumococci, the most appropriate antibiotics less clear. In the media

otitis media, amoxicillin is still represented the best choice, as

drug levels achieved in the ear

average may still exceed the IPC strains with intermediate resistance >> << , (although higher doses may be necessary). Other oral drugs

Australia for use in children (Cefaclor, trimethoprim, erythromycin and

tsefpodoksym) does not reach a sufficient level to eradicate

isolates. Third generation cephalosporins

such as ceftriaxone, are active, but th

through parenteral probably preclude their use. Association

clavulanic acid with amoxicillin does not provide any advantage because resistance >> << no associated lactamases.

For high level penicillin-resistant strains was observed

be satisfactory oral agent. The reasons for the increase of resistance in S. pneumonia worldwide

not fully elucidated, although antibiotic pressure >> << is an important factor. A few resistant clones showed that spread from one continent

others (for example, from Spain to the United States and Iceland

), then by the local population are minor genetic changes >> << in the process. Pneumococcus can buy

DNA of other bacteria that are likely to include viridens

group streptococci (eg,

Streptococcus tShz), which form

part of the normal flora of the nasopharynx. Although it is likely to be

impossible to eradicate carriage of resistant organisms

-population, it may be possible to reduce the rates of resistance >> << appointment by minimizing unnecessary antibiotic

. Other strategies such as vaccination, may be needed. Unfortunately, at present vaccine >> << polysaccharides and therefore bad immunohena, especially in young children. Conducted research to assess the conjugated pneumococcal vaccine

(eg, carbohydrates with protein-carrier), but vaccine development

difficult because there are more than 80 serotypes of pneumococcus

(compared with only one usually invasive serotype

Haemophilus influenzae - type B). However, currently most

on resistant organisms belonging to the relatively small serotypes. The vaccine, which contains most of qi

can not only reduce life-threatening disease, but can also reduce transportation

organisms, as found

H. Influenza

type B (Hib) vaccine. However, the pneumococcus can buy

DNA of other organisms

number of resistant serotypes are likely to increase. Our study was one of the largest in the world where all organisms are >> << clinically significant and all were evaluated at the microphone to penicillin. It is valuable not only to display the speed of resistance (as

medium and high), and to provide the basic for

assessment of future changes in resistance and to distinguish subtle

changes in the resistance of the whole population of pneumococci

implementation of stable clones. Last IPC definition was laborious, painstaking, and not << normal >>. A recent development ETest (consisting of bands

on paper impregnated with increasing buy strattera concentrations of antibiotic >> << from end to end) simplified the procedure. This technological progress and the willingness of many

laboratories across Australia to participate in the project, has

possible to obtain information necessary to direct us to do

appropriate antibiotic selection and design of empirical therapy

these new threats. .