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JAC Advance Access originally published online on January 27, 2009
Journal of Antimicrobial Chemotherapy 2009 63(3):511-519; doi:10.1093/jac/dkn538
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© The Author 2009. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Original research

Susceptibilities of Haemophilus influenzae, Streptococcus pneumoniae, including serotype 19A, and Moraxella catarrhalis paediatric isolates from 2005 to 2007 to commonly used antibiotics

Christopher J. Harrison1,*, Charles Woods2, Gordon Stout2, Brittanie Martin3 and Rangaraj Selvarangan4

1 Pediatric Infectious Diseases Section, Children’s Mercy Hospital and Clinics, and the University of Missouri-Kansas City, Kansas City, MO, USA 2 Pediatric Infectious Diseases, University of Louisville, Louisville, KY, USA 3 University of Missouri, Columbia, MO, USA 4 Department of Pathology, Children’s Mercy Hospital and Clinics, and the University of Missouri-Kansas City, Kansas City, MO, USA

Received 24 June 2008; returned 7 August 2008; revised 31 October 2008; accepted 12 December 2008

* Corresponding author. Tel: +1-816-234-3061; Fax: +1-816-346-1328; E-mail: cjharrison{at}cmh.edu

Objectives: The aim of this study was to evaluate susceptibility to common paediatric antibiotics for Streptococcus pneumoniae, non-typeable Haemophilus influenzae and Moraxella catarrhalis isolated from 2005 through 2007.

Methods: Microdilution MIC assays were performed using CLSI-approved methods. S. pneumoniae 19A strains were identified by quellung reaction.

Results: Among 143 non-typeable H. influenzae, 42% produced β-lactamase. By 2007 breakpoints (PK/PD:CLSI), percentage susceptibility for non-typeable H. influenzae was: ceftriaxone = cefixime = high-dose amoxicillin/clavulanate (all 100%:100%) > standard-dose amoxicillin/clavulanate (91.6%:100%) > cefuroxime axetil (88.1%:99.3%) > cefdinir (83.9%:100%) > trimethoprim/sulfamethoxazole (73.4%:73.4%) >high-dose amoxicillin (58%:58%) > standard-dose amoxicillin (55.2%:58%) > cefprozil (28.7%:83.2%) > cefaclor (3.5%:83.2%) > azithromycin (0%:87.4%). Of 208 S. pneumoniae (42 serotype 19A), 86 were penicillin-susceptible, 60 were penicillin-intermediate and 62 were penicillin-resistant by 2007 CLSI breakpoints. Percentage susceptibility for all S. pneumoniae/19A by PD breakpoints was: ceftriaxone (95.2%/86.1%) > high-dose amoxicillin (89.4%/58.3%) > clindamycin (85%/58.3%) > standard-dose amoxicillin (73.5%/33.3%) > cefuroxime axetil (69.2%/36.1%), cefprozil (67.3%/33.3%) > cefdinir (59.1%/33.3%) > cefixime (57.7%/33.3%) > azithromycin (56.7%/33.3%) > trimethoprim/sulfamethoxazole (50.5%/25%) > penicillin (41.3%/19.4%) > cefaclor (28.8%/8.3%). Percentage M. catarrhalis (n = 62) susceptibility by PK/PD breakpoints was: high-dose amoxicillin/clavulanate = cefixime (100%) > azithromycin (98.4%) > ceftriaxone (96.8%) > standard-dose amoxicillin/clavulanate (88.7%) > cefdinir (80.6%) > cefprozil = cefuroxime axetil (37.1%) > high-dose amoxicillin (11.2%) > cefaclor (6.5%) > standard-dose amoxicillin (4.8%).

Conclusions: Despite high rates of β-lactamase production among non-typeable H. influenzae and M. catarrhalis, multiple oral treatment options exist for non-typeable H. influenzae and M. catarrhalis. Multidrug-resistant serotype 19A S. pneumoniae (~20%) limits treatment options for ambulatory S. pneumoniae respiratory disease.

Keywords: amoxicillin , azithromycin , cephalosporins , clindamycin , PCV7 , otitis


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