Antibiotic resistant infections due to Streptococcus pneumoniae: Impact on therapeutic options and clinical outcome

Purpose of review: Streptococcus pneumoniae is a major cause of morbidity and mortality in the pediatric population. The development of increasing resistance to multiple classes of antibiotics is making treatment of infections due to this organism much more difficult. The ultimate impact of high-level antibiotic resistance on therapeutic options and clinical outcomes of various pneumococcal infections is unclear and remains to be determined. Use of the conjugate pneumococcal vaccine has markedly decreased invasive pneumococcal disease in children under 5 years of age; however, its impact on decreasing antibiotic resistance is currently unknown. Recent findings: Studies suggest that response to therapy and clinical outcome of infections due to pneumococcal isolates with intermediate resistance to the β-lactam antibiotics is no different from that of infections due to susceptible isolates. However, evidence is accumulating that infections caused by highly resistant pneumococcal isolates are associated with higher rates of treatment failure and mortality than infections due to susceptible strains. Summary: Use of a conjugate pneumococcal vaccine in conjunction with educational intervention programs that promote appropriate and judicious antibiotic use is a safe and effective means of decreasing the prevalence of pneumococcal disease in the pediatric population, decreasing the use of broad-spectrum antibiotic agents and potentially decreasing the amount of antibiotic resistance currently being seen.