Medicus, Vol. 14 No. 1_ARI, 2005.
Review article
Clinical Implications of Antibiotic Resistance in Acute Respiratory Infections
Arjana Tambić Andrašević
Abstract
The major bacterial respiratory pathogens
Streptococcus pneumoniae, group A streptococcus (GAS),
Haemophilus infl uenzae and Moraxella catarrhalis were
considered sensitive to antibiotics for a long time. The
overuse of antibiotics has, however, led to the development
of numerous resistance mechanisms to various antibiotics.
The increasing resistance to beta-lactams and macrolides
is of special interest in the treatment of respiratory
infections. In Croatia, 29% of pneumococci are moderately
and 3% highly resistant to penicillin, while resistance to
macrolides is 27%. There is no penicillin resistance in GAS,
but resistance to macrolides in Croatia is 14%. Almost all
strains of M. catarrhalis and many strains of Haemophilus
infl uenzae (10% in Croatia) produce beta-lactamases and
are therefore resistant to amoxicillin, but not to the
amoxicillin and beta-lactamase inhibitor combinations. In
vitro sensitivity of the causing agent is very important for
the successful therapy, but the outcome of the disease also
depends on the intrinsic virulence of the microorganism
and host defence capability. Pharmacokinetic (PK) and
pharmacodynamic (PD) parameters signifi cantly infl uence
the in vivo effi cacy of an antibiotic and are increasingly used
to improve antibiotic dosing and in vitro testing. So far the
increase of antibiotic resistance in respiratory pathogens
has not been followed by a dramatic increase in mortality
due to respiratory infections. However, death is only a crude
indicator of the outcome of the disease.
Keywords
resistance; respiratory pathogens; antimicrobial therapy; resistance surveliance
Hrčak ID:
18830
URI
Publication date:
26.1.2005.
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