Skip to main content
PMC home page
Canadian Family Physician logoLink to Canadian Family Physician
. 1998 Sep;44:1881–1888.

Antibiotic-resistant Streptococcus pneumoniae. Implications for medical practice.

E E Wang 1, J D Kellner 1, S Arnold 1
PMCID: PMC2277883  PMID: 9789668

Abstract

OBJECTIVE: To review the definition and prevalence of antibiotic-resistant Streptococcus pneumoniae, its links with antibiotic prescribing, data on antibiotic prescribing and prescribing appropriateness, and evidence-based treatment guidelines for common respiratory tract syndromes. QUALITY OF EVIDENCE: Primary studies consist of cross-sectional surveys and case-control studies. Treatment guidelines are based on clinical trials, meta-analyses, and cohort studies. Study designs were appropriate for the specific study questions. MAIN FINDINGS: The increasing prevalence of penicillin-resistant S pneumoniae is concurrent with increasing antibiotic prescribing. Individual patients show a twofold to ninefold increase in nasopharyngeal carriage of resistant bacteria or invasion with resistant bacteria (among those who have received antibiotics in the preceding 3 months). Cross-sectional data as well as data from medicaid and drug databases attest to overprescribing of antibiotics for respiratory tract infections. Physician surveys and focus groups blame this on parental pressure for antibiotic prescriptions. However, parents in focus groups and surveys deny they pressure their physicians and indicate their main purpose for office visits is to obtain a diagnosis and to seek reassurance that their children are not seriously ill. Evidence-based guidelines suggest treatment strategies that would reduce antibiotic prescribing. CONCLUSIONS: The few antibiotics that can be used with resistant organisms are expensive and are increasingly being needed. To control the rise of antibiotic resistance, it is important to limit antibiotic overprescribing.

Full text

PDF
1885

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ahronheim G. A., Reich B., Marks M. I. Penicillin-insensitive pneumococci. Case report and review. Am J Dis Child. 1979 Feb;133(2):187–191. doi: 10.1001/archpedi.1979.02130020079017. [DOI] [PubMed] [Google Scholar]
  2. Amitai Y., Rotenberg M., Wirtschafter D., Haas H., Michel J. Increasing frequency of penicillin-resistant pneumococci: epidemiological aspects and case-control study. Isr J Med Sci. 1985 Apr;21(4):340–345. [PubMed] [Google Scholar]
  3. Appelbaum P. C. World-wide development of antibiotic resistance in pneumococci. Eur J Clin Microbiol. 1987 Aug;6(4):367–377. doi: 10.1007/BF02013089. [DOI] [PubMed] [Google Scholar]
  4. Arnold K. E., Leggiadro R. J., Breiman R. F., Lipman H. B., Schwartz B., Appleton M. A., Cleveland K. O., Szeto H. C., Hill B. C., Tenover F. C. Risk factors for carriage of drug-resistant Streptococcus pneumoniae among children in Memphis, Tennessee. J Pediatr. 1996 Jun;128(6):757–764. doi: 10.1016/s0022-3476(96)70326-8. [DOI] [PubMed] [Google Scholar]
  5. Block S. L., Harrison C. J., Hedrick J. A., Tyler R. D., Smith R. A., Keegan E., Chartrand S. A. Penicillin-resistant Streptococcus pneumoniae in acute otitis media: risk factors, susceptibility patterns and antimicrobial management. Pediatr Infect Dis J. 1995 Sep;14(9):751–759. doi: 10.1097/00006454-199509000-00005. [DOI] [PubMed] [Google Scholar]
  6. Boken D. J., Chartrand S. A., Goering R. V., Kruger R., Harrison C. J. Colonization with penicillin-resistant Streptococcus pneumoniae in a child-care center. Pediatr Infect Dis J. 1995 Oct;14(10):879–884. doi: 10.1097/00006454-199510000-00012. [DOI] [PubMed] [Google Scholar]
  7. Breiman R. F., Butler J. C., Tenover F. C., Elliott J. A., Facklam R. R. Emergence of drug-resistant pneumococcal infections in the United States. JAMA. 1994 Jun 15;271(23):1831–1835. [PubMed] [Google Scholar]
  8. Brook I., Gober A. E. Prophylaxis with amoxicillin or sulfisoxazole for otitis media: effect on the recovery of penicillin-resistant bacteria from children. Clin Infect Dis. 1996 Jan;22(1):143–145. doi: 10.1093/clinids/22.1.143. [DOI] [PubMed] [Google Scholar]
  9. Butler J. C., Hofmann J., Cetron M. S., Elliott J. A., Facklam R. R., Breiman R. F. The continued emergence of drug-resistant Streptococcus pneumoniae in the United States: an update from the Centers for Disease Control and Prevention's Pneumococcal Sentinel Surveillance System. J Infect Dis. 1996 Nov;174(5):986–993. doi: 10.1093/infdis/174.5.986. [DOI] [PubMed] [Google Scholar]
  10. Cowan P. F. Patient satisfaction with an office visit for the common cold. J Fam Pract. 1987 Apr;24(4):412–413. [PubMed] [Google Scholar]
  11. Dixon J. M., Lipinski A. E., Graham M. E. Detection and prevalence of pneumococci with increased resistance to penicillin. Can Med Assoc J. 1977 Nov 19;117(10):1159–1161. [PMC free article] [PubMed] [Google Scholar]
  12. Doern G. V., Brueggemann A., Holley H. P., Jr, Rauch A. M. Antimicrobial resistance of Streptococcus pneumoniae recovered from outpatients in the United States during the winter months of 1994 to 1995: results of a 30-center national surveillance study. Antimicrob Agents Chemother. 1996 May;40(5):1208–1213. doi: 10.1128/aac.40.5.1208. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Doern G. V. Trends in antimicrobial susceptibility of bacterial pathogens of the respiratory tract. Am J Med. 1995 Dec 29;99(6B):3S–7S. doi: 10.1016/s0002-9343(99)80303-9. [DOI] [PubMed] [Google Scholar]
  14. Duchin J. S., Breiman R. F., Diamond A., Lipman H. B., Block S. L., Hedrick J. A., Finger R., Elliott J. A. High prevalence of multidrug-resistant Streptococcus pneumoniae among children in a rural Kentucky community. Pediatr Infect Dis J. 1995 Sep;14(9):745–750. doi: 10.1097/00006454-199509000-00004. [DOI] [PubMed] [Google Scholar]
  15. Friedland I. R., Klugman K. P. Antibiotic-resistant pneumococcal disease in South African children. Am J Dis Child. 1992 Aug;146(8):920–923. doi: 10.1001/archpedi.1992.02160200042023. [DOI] [PubMed] [Google Scholar]
  16. Gable C. B., Holzer S. S., Engelhart L., Friedman R. B., Smeltz F., Schroeder D., Baum K. Pneumococcal vaccine. Efficacy and associated cost savings. JAMA. 1990 Dec 12;264(22):2910–2915. doi: 10.1001/jama.264.22.2910. [DOI] [PubMed] [Google Scholar]
  17. Gadomski A. M. Potential interventions for preventing pneumonia among young children: lack of effect of antibiotic treatment for upper respiratory infections. Pediatr Infect Dis J. 1993 Feb;12(2):115–120. doi: 10.1097/00006454-199302000-00002. [DOI] [PubMed] [Google Scholar]
  18. García-Leoni M. E., Cercenado E., Rodeño P., Bernaldo de Quirós J. C., Martínez-Hernández D., Bouza E. Susceptibility of Streptococcus pneumoniae to penicillin: a prospective microbiological and clinical study. Clin Infect Dis. 1992 Feb;14(2):427–435. doi: 10.1093/clinids/14.2.427. [DOI] [PubMed] [Google Scholar]
  19. Hamm R. M., Hicks R. J., Bemben D. A. Antibiotics and respiratory infections: are patients more satisfied when expectations are met? J Fam Pract. 1996 Jul;43(1):56–62. [PubMed] [Google Scholar]
  20. Hofmann J., Cetron M. S., Farley M. M., Baughman W. S., Facklam R. R., Elliott J. A., Deaver K. A., Breiman R. F. The prevalence of drug-resistant Streptococcus pneumoniae in Atlanta. N Engl J Med. 1995 Aug 24;333(8):481–486. doi: 10.1056/NEJM199508243330803. [DOI] [PubMed] [Google Scholar]
  21. Jackson M. A., Shelton S., Nelson J. D., McCracken G. H., Jr Relatively penicillin-resistant pneumococcal infections in pediatric patients. Pediatr Infect Dis. 1984 Mar-Apr;3(2):129–132. doi: 10.1097/00006454-198403000-00010. [DOI] [PubMed] [Google Scholar]
  22. Jacobs M. R., Koornhof H. J., Robins-Browne R. M., Stevenson C. M., Vermaak Z. A., Freiman I., Miller G. B., Witcomb M. A., Isaäcson M., Ward J. I. Emergence of multiply resistant pneumococci. N Engl J Med. 1978 Oct 5;299(14):735–740. doi: 10.1056/NEJM197810052991402. [DOI] [PubMed] [Google Scholar]
  23. Kai J. Parents' difficulties and information needs in coping with acute illness in preschool children: a qualitative study. BMJ. 1996 Oct 19;313(7063):987–990. doi: 10.1136/bmj.313.7063.987. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Kam K. M., Luey K. Y., Fung S. M., Yiu P. P., Harden T. J., Cheung M. M. Emergence of multiple-antibiotic-resistant Streptococcus pneumoniae in Hong Kong. Antimicrob Agents Chemother. 1995 Dec;39(12):2667–2670. doi: 10.1128/aac.39.12.2667. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Klugman K. P. Pneumococcal resistance to antibiotics. Clin Microbiol Rev. 1990 Apr;3(2):171–196. doi: 10.1128/cmr.3.2.171. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Lee H. J., Park J. Y., Jang S. H., Kim J. H., Kim E. C., Choi K. W. High incidence of resistance to multiple antimicrobials in clinical isolates of Streptococcus pneumoniae from a university hospital in Korea. Clin Infect Dis. 1995 Apr;20(4):826–835. doi: 10.1093/clinids/20.4.826. [DOI] [PubMed] [Google Scholar]
  27. Mainous A. G., 3rd, Hueston W. J., Clark J. R. Antibiotics and upper respiratory infection: do some folks think there is a cure for the common cold. J Fam Pract. 1996 Apr;42(4):357–361. [PubMed] [Google Scholar]
  28. Marchese A., Debbia E. A., Arvigo A., Pesce A., Schito G. C. Susceptibility of Streptococcus pneumoniae strains isolated in Italy to penicillin and ten other antibiotics. J Antimicrob Chemother. 1995 Nov;36(5):833–837. doi: 10.1093/jac/36.5.833. [DOI] [PubMed] [Google Scholar]
  29. Marton A. Pneumococcal antimicrobial resistance: the problem in Hungary. Clin Infect Dis. 1992 Jul;15(1):106–111. doi: 10.1093/clinids/15.1.106. [DOI] [PubMed] [Google Scholar]
  30. Mayefsky J. H., el-Shinaway Y., Kelleher P. Families who seek care for the common cold in a pediatric emergency department. J Pediatr. 1991 Dec;119(6):933–934. doi: 10.1016/s0022-3476(05)83047-1. [DOI] [PubMed] [Google Scholar]
  31. McCaig L. F., Hughes J. M. Trends in antimicrobial drug prescribing among office-based physicians in the United States. JAMA. 1995 Jan 18;273(3):214–219. [PubMed] [Google Scholar]
  32. McDougal L. K., Rasheed J. K., Biddle J. W., Tenover F. C. Identification of multiple clones of extended-spectrum cephalosporin-resistant Streptococcus pneumoniae isolates in the United States. Antimicrob Agents Chemother. 1995 Oct;39(10):2282–2288. doi: 10.1128/aac.39.10.2282. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. McIsaac W. J., Goel V., Slaughter P. M., Parsons G. W., Woolnough K. V., Weir P. T., Ennet J. R. Reconsidering sore throats. Part 2: Alternative approach and practical office tool. Can Fam Physician. 1997 Mar;43:495–500. [PMC free article] [PubMed] [Google Scholar]
  34. McIsaac W. J., Goel V., Slaughter P. M., Parsons G. W., Woolnough K. V., Weir P. T., Ennet J. R. Reconsidering sore throats. Part I: Problems with current clinical practice. Can Fam Physician. 1997 Mar;43:485–493. [PMC free article] [PubMed] [Google Scholar]
  35. McIsaac W. J., White D., Tannenbaum D., Low D. E. A clinical score to reduce unnecessary antibiotic use in patients with sore throat. CMAJ. 1998 Jan 13;158(1):75–83. [PMC free article] [PubMed] [Google Scholar]
  36. Mittermayer H., Jebelean C., Binder L., Haditsch M., Watschinger R. Antibiotic susceptibility of pneumococci isolated in Austria over a four-year period. Eur J Clin Microbiol Infect Dis. 1996 Oct;15(10):817–820. doi: 10.1007/BF01701526. [DOI] [PubMed] [Google Scholar]
  37. Nava J. M., Bella F., Garau J., Lite J., Morera M. A., Martí C., Fontanals D., Font B., Pineda V., Uriz S. Predictive factors for invasive disease due to penicillin-resistant Streptococcus pneumoniae: a population-based study. Clin Infect Dis. 1994 Nov;19(5):884–890. doi: 10.1093/clinids/19.5.884. [DOI] [PubMed] [Google Scholar]
  38. Neu H. C. The crisis in antibiotic resistance. Science. 1992 Aug 21;257(5073):1064–1073. doi: 10.1126/science.257.5073.1064. [DOI] [PubMed] [Google Scholar]
  39. Pabst H. F., Nigrin J. Penicillin resistance of pneumococci and immune deficiency. Lancet. 1979 Aug 18;2(8138):359–360. doi: 10.1016/s0140-6736(79)90369-6. [DOI] [PubMed] [Google Scholar]
  40. Pallares R., Gudiol F., Liñares J., Ariza J., Rufi G., Murgui L., Dorca J., Viladrich P. F. Risk factors and response to antibiotic therapy in adults with bacteremic pneumonia caused by penicillin-resistant pneumococci. N Engl J Med. 1987 Jul 2;317(1):18–22. doi: 10.1056/NEJM198707023170104. [DOI] [PubMed] [Google Scholar]
  41. Pallares R., Liñares J., Vadillo M., Cabellos C., Manresa F., Viladrich P. F., Martin R., Gudiol F. Resistance to penicillin and cephalosporin and mortality from severe pneumococcal pneumonia in Barcelona, Spain. N Engl J Med. 1995 Aug 24;333(8):474–480. doi: 10.1056/NEJM199508243330802. [DOI] [PubMed] [Google Scholar]
  42. Pianosi P., Feldman W., Robson M. G., McGillivray D. Inappropriate use of antibiotics in croup at three types of hospital. CMAJ. 1986 Feb 15;134(4):357–359. [PMC free article] [PubMed] [Google Scholar]
  43. Radetsky M. S., Istre G. R., Johansen T. L., Parmelee S. W., Lauer B. A., Wiesenthal A. M., Glode M. P. Multiply resistant pneumococcus causing meningitis: its epidemiology within a day-care centre. Lancet. 1981 Oct 10;2(8250):771–773. doi: 10.1016/s0140-6736(81)90184-7. [DOI] [PubMed] [Google Scholar]
  44. Reichler M. R., Allphin A. A., Breiman R. F., Schreiber J. R., Arnold J. E., McDougal L. K., Facklam R. R., Boxerbaum B., May D., Walton R. O. The spread of multiply resistant Streptococcus pneumoniae at a day care center in Ohio. J Infect Dis. 1992 Dec;166(6):1346–1353. doi: 10.1093/infdis/166.6.1346. [DOI] [PubMed] [Google Scholar]
  45. Robins-Browne R. M., Kharsany A. B., Koornhof H. J. Antibiotic-resistant pneumococci in hospitalized children. J Hyg (Lond) 1984 Aug;93(1):9–16. doi: 10.1017/s0022172400060873. [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Sanchez-Menegay C., Hudes E. S., Cummings S. R. Patient expectations and satisfaction with medical care for upper respiratory infections. J Gen Intern Med. 1992 Jul-Aug;7(4):432–434. doi: 10.1007/BF02599162. [DOI] [PubMed] [Google Scholar]
  47. Seppälä H., Klaukka T., Vuopio-Varkila J., Muotiala A., Helenius H., Lager K., Huovinen P. The effect of changes in the consumption of macrolide antibiotics on erythromycin resistance in group A streptococci in Finland. Finnish Study Group for Antimicrobial Resistance. N Engl J Med. 1997 Aug 14;337(7):441–446. doi: 10.1056/NEJM199708143370701. [DOI] [PubMed] [Google Scholar]
  48. Setchanova L. Clinical isolates and nasopharyngeal carriage of antibiotic-resistant Streptococcus pneumoniae in Hospital for Infectious Diseases, Sofia, Bulgaria, 1991-1993. Microb Drug Resist. 1995 Spring;1(1):79–84. doi: 10.1089/mdr.1995.1.79. [DOI] [PubMed] [Google Scholar]
  49. Simor A. E., Louie M., Low D. E. Canadian national survey of prevalence of antimicrobial resistance among clinical isolates of Streptococcus pneumoniae. Canadian Bacterial Surveillance Network. Antimicrob Agents Chemother. 1996 Sep;40(9):2190–2193. doi: 10.1128/aac.40.9.2190. [DOI] [PMC free article] [PubMed] [Google Scholar]
  50. Spika J. S., Facklam R. R., Plikaytis B. D., Oxtoby M. J. Antimicrobial resistance of Streptococcus pneumoniae in the United States, 1979-1987. The Pneumococcal Surveillance Working Group. J Infect Dis. 1991 Jun;163(6):1273–1278. doi: 10.1093/infdis/163.6.1273. [DOI] [PubMed] [Google Scholar]
  51. Stephenson J. Icelandic researchers are showing the way to bring down rates of antibiotic-resistant bacteria. JAMA. 1996 Jan 17;275(3):175–175. [PubMed] [Google Scholar]
  52. Swartz M. N. Use of antimicrobial agents and drug resistance. N Engl J Med. 1997 Aug 14;337(7):491–492. doi: 10.1056/NEJM199708143370709. [DOI] [PubMed] [Google Scholar]
  53. Tan T. Q., Mason E. O., Jr, Kaplan S. L. Penicillin-resistant systemic pneumococcal infections in children: a retrospective case-control study. Pediatrics. 1993 Dec;92(6):761–767. [PubMed] [Google Scholar]
  54. Yoshida R., Kaku M., Kohno S., Ishida K., Mizukane R., Takemura H., Tanaka H., Usui T., Tomono K., Koga H. Trends in antimicrobial resistance of Streptococcus pneumoniae in Japan. Antimicrob Agents Chemother. 1995 May;39(5):1196–1198. doi: 10.1128/aac.39.5.1196. [DOI] [PMC free article] [PubMed] [Google Scholar]
  55. Zenni M. K., Cheatham S. H., Thompson J. M., Reed G. W., Batson A. B., Palmer P. S., Holland K. L., Edwards K. M. Streptococcus pneumoniae colonization in the young child: association with otitis media and resistance to penicillin. J Pediatr. 1995 Oct;127(4):533–537. doi: 10.1016/s0022-3476(95)70108-7. [DOI] [PubMed] [Google Scholar]

Articles from Canadian Family Physician are provided here courtesy of College of Family Physicians of Canada

RESOURCES