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. .