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Abstract
Objective
To determine whether reported increases in Streptococcus pneumoniae resistance, as determined by in vitro antimicrobial susceptibility testing, correlate
with the clinical efficacy of clarithromycin in treating patients with acute exacerbations
of chronic bronchitis (AECB) or community-acquired pneumonia (CAP).
Background
Surveillance data on antimicrobial resistance suggest that the overall rate of S pneumoniae resistance in vitro in the United States has increased to ~45% during the past decade.
S pneumoniae is showing increased resistance to penicillin, other betalactams, and macrolides.
Despite this increased resistance, the clinical efficacy of clarithromycin does not
appear to be diminished to the degree suggested by reported resistance rates. The
author examined several studies of clarithromycin in patients with AECB or CAP that
demonstrate S pneumoniae eradication rates in vivo of ~92%. The discordance between reported increases in
resistance of S pneumoniae isolates in vitro and the eradication rate with clarithromycin in vivo is discussed
in light of 5 observations.
Results
First, surveillance data on S pneumoniae resistance rates to clarithromycin may be overestimated. Second, efflux mutant strains
may not be clinically resistant. Third, host immune defenses play a role in treatment
outcomes. Fourth, in vitro resistance may not correlate with in vivo clinical success.
Finally, clarithromycin and its active metabolite, 14-OH-clarithromycin, attain high
concentrations in patients.
Conclusion
Reported increases in the prevalence of S pneumoniae resistance do not appear to have had proportional effects on the clinical efficacy
of clarithromycin in the treatment of patients with AECB or CAP caused by S pneumoniae.
Key words
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Article info
Publication history
Accepted:
December 22,
1999
Identification
Copyright
© 2000 Published by Elsevier Inc.
