Journal of Antimicrobial Chemotherapy (2002) 49, 433-436
© 2002 The British Society for Antimicrobial Chemotherapy
Leading article |
The in vivo–in vitro paradox in pneumococcal respiratory tract infections
Department of Medicine, Division of Infectious Diseases, Center for Tuberculosis Research, Johns Hopkins School of Medicine, 424 N. Bond Street, Baltimore, MD 21231-1001, USA
Streptococcus pneumoniae is the most commonly identified cause of community-acquired pneumonia, accounting for 9–55% of cases among patients requiring hospitalization.1 Although resistance to penicillin and other antimicrobial agents among S. pneumoniae was initially recognized in 1967,2 the prevalence of drug-resistant S. pneumoniae (DRSP) remained low until the early 1990s, when penicillin resistance began to increase at an alarming rate. Current estimates indicate that c. 18% of S. pneumoniae strains from the US have intermediate penicillin resistance (MIC 0.12–1.0 mg/L) and 33% have high-level resistance (MIC 
2 mg/L).3,4 Some estimates have placed the increase in high-level penicillin resistance among S. pneumoniae at 60-fold over the past 5–7 years.5,6 Outside the US, resistance to penicillin is even higher, with Spain, Hungary and South Africa reporting rates of intermediate and high-level resistance between 40 and 70%.7–9 Nevertheless, the clinical relevance of antimicrobial resistance in pneumococcal respiratory tract infections remains surprisingly uncertain.
The
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