Document 0830
 DOCN  M9650830
 TI    Comparison of the response to antimicrobial therapy of
       penicillin-resistant and penicillin-susceptible pneumococcal disease.
 DT    9605
 AU    Friedland IR; Department of Pediatrics, Baragwanath Hospital, South
       Africa.
 SO    Pediatr Infect Dis J. 1995 Oct;14(10):885-90. Unique Identifier :
       AIDSLINE MED/96117427
 AB    The continued spread of penicillin-resistant pneumococci raises
       therapeutic concerns. Optimal therapy for resistant infections is
       unknown and it is not clear whether the efficacy of penicillin or
       equally active beta-lactam agents is compromised in
       non-meningeal-resistant infections. A prospective nonintervention study
       was undertaken to compare the clinical response in penicillin-resistant
       vs. penicillin-susceptible bacteremic pneumococcal infections, excluding
       meningitis. Of 108 children enrolled, 35 (32%) had penicillin-resistant
       (one highly resistant) isolates. Seventy-eight children had pneumonia,
       21 had occult bacteremia (sepsis) and 9 had peritonitis. Children with
       resistant infections were more likely to have underlying disorders,
       especially human immunodeficiency virus infection, and to have received
       antimicrobial therapy in the previous month. After 48 hours of therapy
       64% of penicillin-susceptible infections showed improvement vs. 60% of
       penicillin-resistant infections (odds ratio, 1.2; 95% confidence
       intervals, 0.5 to 3.0). In children with pneumonia treated with
       ampicillin or an equivalent beta-lactam agent, 93% with
       penicillin-susceptible infections had improved by Day 7 of therapy
       compared with 88% with resistant infections (odds ratio, 1.9; 95%
       confidence interval 0.3 to 15.9). The durations of respiratory distress,
       fever and oxygen requirement were similar in penicillin-susceptible and
       -resistant infections. These results suggest that intermediate
       penicillin resistance is of little significance in pneumococcal
       pneumonia or sepsis and that standard beta-lactam therapy is still
       highly effective. Further studies of highly penicillin-resistant
       infections are necessary.
 DE    Bacteremia/DRUG THERAPY/MORTALITY  Child  Child, Preschool  Comparative
       Study  Female  Human  Infant  Infant, Newborn
       Lactams/PHARMACOLOGY/*THERAPEUTIC USE  Male  Microbial Sensitivity Tests
       Odds Ratio  *Penicillin Resistance  Pneumococcal Infections/*DRUG
       THERAPY/MORTALITY  Pneumonia, Bacterial/DRUG THERAPY  Prospective
       Studies  Risk Factors  Streptococcus pneumoniae/*DRUG EFFECTS  Support,
       Non-U.S. Gov't  Survival Rate  Treatment Outcome  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).