Pneumococcal macrolide resistance—myth or reality?

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Abstract
Streptococcus pneumoniae is one of the most common community-acquired respiratory tract pathogens, causing as many as ≥20% of all cases of community-acquired pneumonia (CAP) annually. 1 Over the years a number of agents have been utilized as first-line treatment options for this organism. Invariably, as various agents have been used extensively, in-vitro antimicrobial resistance has developed. Penicillin-resistant pneumococci (PRP) have become highly prevalent in many countries over the past 10-15 years and are continuing to spread in many regions of the USA. 2 ,3 ,4 ,5 This (and other) trends in resistance, as well as the recognition of the importance of atypical pathogens, resulted in CAP outpatient treatment guidelines being released in 1993 that recommended that the macrolides be utilized as first-line treatment for patients 6 This line of thinking has recently been reinforced by the Infectious Diseases Society of America with their 1998 CAP treatment guidelines. 7 As a result of these recommendations together with, resistance trends, and the advantages of the new azalide azithromycin and the macrolide clarithromycin having antimicrobial activity against all relevant community-acquired respiratory pathogens, these agents have been heavily prescribed over the past few years. 8