Antibiotic resistance in Streptococcus pneumoniae

Resistance to penicillin and other antibiotics in Streptococcus pneumoniae has emerged in Australia and around the world in the past decade, and appea rs to be worsening (eg, rates of penicillin resistance in Australia rose fr om 1% in 1989 to 25% in 1997). In Australia, the only oral antibiotic able to treat respiratory infections caused by some multiresistant strains is high-dose amoxycillin. If these s trains increase in prevalence, then treatment failures for relatively minor infections (eg, otitis media) are likely to become common, resulting in re peat antibiotic courses or hospitalisation for parenteral therapy. Therapy for meningitis caused by penicillin-sensitive pneumococcal strains remains high-dose benzylpenicillin, but empirical treatment while awaiting culture and sensitivity results is problematic; neither penicillin nor thir d-generation cephalosporins coverall strains. Therefore, many authorities r ecommend vancomycin, usually combined with a third-generation cephalosporin , for treating presumptive or proven pneumococcal meningitis pending penici llin-susceptibility results. As almost all readily available oral antibiotics in Australia select for re sistant strains of pneumococci, multiresistant strains will increase in pre valence unless unnecessary antibiotic use and prescription volumes are redu ced substantially in the next few years.