Penicillin-resistant Streptococcus pneumoniae: selection by both β-lactam and non-β-lactam antibiotics

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Abstract
In recent years there has been a dramatic increase, worldwide, in the prevalence of so-called penicillin-resistant Streptococcus pneumoniae (PRSP);1 in some European countries and certain regions of the USA, South America and South East Asia, prevalences currently exceed 40–50%. The overall increase has been attributed to excessive global usage of antibiotics, particularly β -lactams, and, in an attempt to address this problem, it has been proposed that prescribing of these drugs should be reduced or avoided altogether. Clearly such an initiative is impractical in those clinical settings in which β-lactams are considered essential therapeutic agents. The more realistic strategy continues to be identification of those patients who require antibiotics and prescription of the most active compound at the optimal dosage for the optimal duration. Insofar as it is possible, the drug chosen should also have a low propensity for selecting resistant strains.

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