The incidence of penicillin resistance in pneumococci is increasing in the
USA, having risen from <5% before 1989 to >35% in 1997. There has also been
a shift in the ratio of intermediate to high-level resistance from 3 or 4:
1 to 2 or 1:1. Multidrug resistance and resistance to macrolides and fluoro
quinolones in pneumococci is also a matter of concern. The implications for
empirical treatment of respiratory tract infections are considerable. The
potential of quinolones with activity against respiratory pathogens includi
ng pneumococci must be preserved by careful antimicrobial prescribing.