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Multidrug-resistant Streptococcus pneumoniae infections: current and future therapeutic options.

Onglets principaux

Van Bambeke, Françoise [UCL] Reinert, René R Appelbaum, Peter C Tulkens, Paul M. [UCL] Peetermans, Willy E

Antibacterial resistance in Streptococcus pneumoniae is increasing worldwide, affecting principally beta-lactams and macrolides (prevalence ranging between approximately 1% and 90% depending on the geographical area). Fluoroquinolone resistance has also started to emerge in countries with high level of antibacterial resistance and consumption. Of more concern, 40% of pneumococci display multi-drug resistant phenotypes, again with highly variable prevalence among countries. Infections caused by resistant pneumococci can still be treated using first-line antibacterials (beta-lactams), provided the dosage is optimised to cover less susceptible strains. Macrolides can no longer be used as monotherapy, but are combined with beta-lactams to cover intracellular bacteria. Ketolides could be an alternative, but toxicity issues have recently restricted the use of telithromycin in the US. The so-called respiratory fluoroquinolones offer the advantages of easy administration and a spectrum covering extracellular and intracellular pathogens. However, their broad spectrum raises questions regarding the global risk of resistance selection and their safety profile is far from optimal for wide use in the community. For multi-drug resistant pneumococci, ketolides and fluoroquinolones could be considered. A large number of drugs with activity against these multi-drug resistant strains (cephalosporins, carbapenems, glycopeptides, lipopeptides, ketolides, lincosamides, oxazolidinones, glycylcyclines, quinolones, deformylase inhibitors) are currently in development. Most of them are only new derivatives in existing classes, with improved intrinsic activity or lower susceptibility to resistance mechanisms. Except for the new fluoroquinolones, these agents are also primarily targeted towards methicillin-resistant Staphylococcus aureus infections; therefore, demonstration of their clinical efficacy in the management of pneumococcal infections is still awaited.

Type de document Article de périodique (Journal article) – Journal Article, Review
Type d'accès Accès restreint
Année de publication 2007
Information sur le périodique "Drugs" - Vol. 67, no. 16, p. 2355-82 (2007)
Peer reviewed oui
issn 0012-6667
Statut de la publication Publié
Affiliations UCL - MD/FARM - Ecole de pharmacie
MESH Subject Anti-Bacterial Agents - therapeutic use ; Drug Resistance, Multiple, Bacterial ; Drug Therapy, Combination ; Fluoroquinolones - therapeutic use ; Humans ; Macrolides - therapeutic use ; Penicillin Resistance ; Pneumococcal Infections - drug therapy ; Streptococcus pneumoniae - drug effects ; beta-Lactams - therapeutic use
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Référence bibliographique Van Bambeke, Françoise ; Reinert, René R ; Appelbaum, Peter C ; Tulkens, Paul M. ; Peetermans, Willy E. Multidrug-resistant Streptococcus pneumoniae infections: current and future therapeutic options.. In: Drugs, Vol. 67, no. 16, p. 2355-82 (2007)
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