Treatment options for resistant pneumococcal infections

In spite of major advances in medical care, infections caused by Streptococcus pneurnorziae continue to be frequent all over the world and are associated with significant morbidity or mortality [l-51. Thus, S. pneurnoniae has remained a major cause of community-acquired pneumonia, acute otitis media and sinusitis, exacerbation of chronic bronchitis, and acute bacterial meningitis [1,3]. The mortality rate in adult patients suffering from severe pneumococcal pneumonia or meningitis may be as high as 30% [1,6]. Over recent years we have seen significant changes in the epidemiology of pneumococcal infections, such as: first, the emergence of S. pneurnoniae strains resistant to penicillin and other antimicrobials [7-131, which has complicated the treatment of such infections; second, the increasing prevalence of pneumococcal infections in specific groups of patients such as those with HIV infection and other immunosuppressive conditions [ 14-1 61; and third, the advanced age of the population, since elderly people are at higher risk for pneumococcal infections [l]. Several options appear to be available to respond to this situation. First, a more appropriate and rational use of antibiotics may significantly reduce the resistance rates [17,18]. Second, the availability of the new antimicrobial agents (e.g. new quinolones) may improve the treatment options for pneumococcal infections [19-22]. Third, future vaccine developments may help in prevention strategies [23,24].