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JAC Advance Access originally published online on January 28, 2003
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Journal of Antimicrobial Chemotherapy (2003) 51, 691-696
© 2003 The British Society for Antimicrobial Chemotherapy

Breakthrough pneumococcal bacteraemia in patients treated with clarithromycin or oral ß-lactams

D. Van Kerkhoven1, W. E. Peetermans2, L. Verbist1 and J. Verhaegen1,*

Departments of 1 Microbiology and 2 Internal Medecine, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium

Received 9 September 2002; returned 7 November 2002; revised 27 November 2002; accepted 4 December 2002

The incidence of penicillin- and erythromycin-resistant strains of Streptococcus pneumoniae has increased considerably in Belgium. The medical charts of all patients with pneumococcal bacteraemia who were admitted to hospital over a period of 3 years (n = 136) were reviewed to identify treatment failure of outpatient antibiotic therapy. Twelve patients had received antibiotics for at least 48 h prior to admission. Four treatment failures received clarithromycin as pre-hospitalization therapy, and S. pneumoniae from all four patients were highly resistant to macrolides. Five patients failed on co-amoxiclav, whereas their S. pneumoniae were susceptible to penicillin and amoxicillin.This observation suggests that macrolide resistance is clinically relevant and leads to treatment failure, whereas suboptimal dosing may explain breakthrough pneumococcal bacteraemia in ß-lactam-treated patients.

Keywords: S. pneumoniae, breakthrough bacteraemia, macrolides, ß-lactams

* Corresponding author. Tel: +32-16-34-70-73; Fax: +32-16-34-79-31; E-mail: jan.verhaegen{at}uz.kuleuven.ac.be


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