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Document 1095
DOCN M9651095
TI Comparison of the response to antimicrobial therapy of
penicillin-resistant and penicillin-susceptible pneumococcal disease.
DT 9505
AU Friedland IR; Department of Pediatrics, Baragwanath Hospital, South
Africa.
SO Pediatr Infect Dis J. 1995 Oct;14(10):885-90. Unique Identifier :
AIDSLINE MED/96117427
AB The continued spread of penicillin-resistant pneumococci raises
therapeutic concerns. Optimal therapy for resistant infections is
unknown and it is not clear whether the efficacy of penicillin or
equally active beta-lactam agents is compromised in
non-meningeal-resistant infections. A prospective nonintervention study
was undertaken to compare the clinical response in penicillin-resistant
vs. penicillin-susceptible bacteremic pneumococcal infections, excluding
meningitis. Of 108 children enrolled, 35 (32%) had penicillin-resistant
(one highly resistant) isolates. Seventy-eight children had pneumonia,
21 had occult bacteremia (sepsis) and 9 had peritonitis. Children with
resistant infections were more likely to have underlying disorders,
especially human immunodeficiency virus infection, and to have received
antimicrobial therapy in the previous month. After 48 hours of therapy
64% of penicillin-susceptible infections showed improvement vs. 60% of
penicillin-resistant infections (odds ratio, 1.2; 95% confidence
intervals, 0.5 to 3.0). In children with pneumonia treated with
ampicillin or an equivalent beta-lactam agent, 93% with
penicillin-susceptible infections had improved by Day 7 of therapy
compared with 88% with resistant infections (odds ratio, 1.9; 95%
confidence interval 0.3 to 15.9). The durations of respiratory distress,
fever and oxygen requirement were similar in penicillin-susceptible and
-resistant infections. These results suggest that intermediate
penicillin resistance is of little significance in pneumococcal
pneumonia or sepsis and that standard beta-lactam therapy is still
highly effective. Further studies of highly penicillin-resistant
infections are necessary.
DE Bacteremia/DRUG THERAPY/MORTALITY Child Child, Preschool Comparative
Study Female Human Infant Infant, Newborn
Lactams/PHARMACOLOGY/*THERAPEUTIC USE Male Microbial Sensitivity Tests
Odds Ratio *Penicillin Resistance Pneumococcal Infections/*DRUG
THERAPY/MORTALITY Pneumonia, Bacterial/DRUG THERAPY Prospective
Studies Risk Factors Streptococcus pneumoniae/*DRUG EFFECTS Support,
Non-U.S. Gov't Survival Rate Treatment Outcome JOURNAL ARTICLE
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).