JAC Advance Access published online on January 28, 2003
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkg116
© 2003 by The British Society for Antimicrobial Chemotherapy
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Original article
1 Department of Microbiology, University
Hospitals Leuven, Herestraat 49,
B-3000 Leuven, Belgium
* Corresponding author. E-mail: jan.verhaegen{at}uz.kuleuven.ac.be.
Received 9 September 2002
; revised 7 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
Keywords: S. pneumoniae, breakthrough
bacteraemia, macrolides, Breakthrough pneumococcal bacteraemia in patients
treated with clarithromycin or oral
-lactams
2 Department of Internal Medecine, University
Hospitals Leuven, Herestraat 49,
B-3000 Leuven, Belgium
-lactam-treated patients.-lactams
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