Description

Streptococcus pneumoniae is a major pathogen in the aetiology of pneumonia, otitis media, bacteraemia and meningitis. Over the past 35 years there has been a world-wide increase in pneumococcal resistance to penicillin and a wide range of other antimicrobial agents. The highest rates of penicillin-resistance in pneumococci have been described in South Africa, Spain and parts of Asia where over 50% of isolates are resis tant. Penicillin resistance is due to changes in penicillinbinding proteins and involves a small number of serotypes, mainly 6, 9, 14, 19 and 23.

Carriage rates of penicillin-resistant pneumococci are higher in children, especially in association with recent hospitalisation or antibiotic consumption. Treatment decisions are based on level of penicillin resistance, the achievable concentration of antibiotic at the site of infection and the sensitivities to alternative agents. Although new antimicrobial agents with good activity against multi-resistant strains have recently been developed, treatment may still be problematic. Outbreaks of infection have occurred in hospitals, nursing homes and day care centres. Control measures include judicious use of antibiotics, isolation of infected hospitalised patients and vaccination.