Penicillins for Treatment of Pneumococcal Pneumonia: Does In Vitro Resistance Really Matter?

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Abstract
Background. The rate of in vitro bacterial resistance to antimicrobial agents is escalating among pathogens that cause the most serious respiratory tract infections. Many reports published during the past few years suggest that this has direct clinical implications. In particular, resistance of Streptococcus pneumoniae to β-lactam antibiotic therapy has assumed a prominent role in the evolution of guidelines for the initial treatment of respiratory tract infection. Methods. I conducted a critical review of the published medical literature. Results. There is only a single report of documented microbiologic failure of parenteral penicillin-class antibiotics in the treatment of pneumococcal pneumonia in patients with or without bacteremia, whereas there are numerous well-documented reports of treatment failure with quinolone-class (n ⩾ 21) and macrolide-class (n ⩾ 33) antibiotics in the treatment of pneumococcal pneumonia. Conclusion. The recommended optimal in-hospital therapy for community-acquired pneumonia should continue to be a β-lactam antibiotic (penicillin, aminopenicillin, cefotaxime, or ceftriaxone) administered with a macrolide or a fluoroquinolone agent for adjunctive treatment of infection with potential atypical pathogens.

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