ANTIBIOTIC MANAGEMENT OF PNEUMOCOCCAL INFECTIONS IN AN ERA OF INCREASED RESISTANCE

Pneumococci are a leading cause of bacterial meningitis and bacteraemi a, as well as pneumonia, otitis media and sinusitis in childhood. Thes e organisms recently have shown a dramatic increase in antibiotic resi stance. Penicillin-resistant pneumococci are of special concern as the y are often resistant to other unrelated antibiotics. This is of parti cular significance to Aboriginal children who have among the highest r ates of pneumococcal infection in the world. Laboratories should now t est all invasive pneumococcal isolates for penicillin and third genera tion cephalosporin resistance, Local treatment guidelines are required for pneumococcal infections, especially for meningitis, taking into a ccount the prevalence of resistant strains within the community. At pr esent, penicillin and amoxycillin remain the drugs of choice for pneum ococcal infections, with the exception of meningitis where initial emp irical therapy must be with a third generation cephalosporin. Judiciou s antibiotic use, which avoids over-prescribing and unnecessary use of broad-spectrum agents, improved living standards in underprivileged c ommunities and introduction of an effective conjugate vaccine, able to reduce the rates of pneumococcal infection and hopefully colonization , may limit the spread of resistant strains.