Bacteremic Pneumonia Caused by Penicillin-Resistant Pneumococci

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To the Editor: Pallares et al. point out (July 2 issue)1 that very little has been published about adult pneumonia due to penicillin-resistant pneumococci, and suggest erythromycin, clindamycin, rifampin, third-generation cephalosporins, vancomycin, or imipenem as alternative therapeutic agents. Using vancomycin, we achieved a cure in a 62-year-old patient with leukemia receiving prednisolone therapy who presented with thrombocytopenia and pneumonia due to highly resistant pneumococci,2 after the patient had had a relapse while receiving β-lactam (cefazolin)–aminoglycoside combination therapy. Third-generation cephalosporins and imipenem may be useful as empirical therapy for this condition, but we are concerned about the use of erythromycin, clindamycin, . . .