Macrolide resistance and treatment failure E-mail from Prof. Schito, 14-11-01 10:56: ”…for me too these days have been impossible, to the point that I have to decline this invi- tation and pass to you all the responsibility. Sorry for that. Regards…..” NF-M, Brussels 2001
Macrolide resistance and treatment failure: Medline search Search string No of hits Erythromycin resistance and treatment failure 61 Macrolide resistance and treatment failure 29 Total: 90 NF-M, Brussels 2001
Macrolide resistance and treatment failure: Types of studies Test of develop- ment of R in individual strains Retrospective studies - single cases of failures (+) if collected - studies of failures (vs. Succ./case contr.) - Prospective studies + Following strains/clinical evaluation Pre->< during >< Post-study strains Experimental/analytical prospective +/- Eg. Study R-developm. Under ab. Pressure in vitro similar to in vivo, compare strains NF-M, Brussels 2001
Macrolide resistance and treatment failure: Bacterial species reported • Actual resistance • MIC > S-conc.: • S. aureus • H. influenzae • S. pneumoniae • P. multocida • S. pyogenes • P. acnes • M. kansasii • T. pallidum • H. pylori NF-M, Brussels 2001
Macrolide resistance and treatment failure: Types of infections • Otitis media • Tonsillitis • Pneumonia • Skin infections - Impetigo, Acne • Dodenal ulcer • Syphilis NF-M, Brussels 2001
Macrolide resistance and treatment failure: Types of infections Macrolide first choice ? • Otitis media no • Tonsillitis no • Pneumonia no • Skin infections - Impetigo, Acne no • Dodenal ulcer no • Syphilis no NF-M, Brussels 2001
Macrolide resistance and treatment failure: Types of macrolides Macrolide Bacterial sp. Type of infection S. aureus, S. pneu., Otitis, tonsillitis, Erythromycin S. pyog., P. acnes impetigo, acne H. pylori Duodenal/ventricular Clarithromycin ulcer S. pneu., S. pyog. Otitis, tonsillitis Azithromycin NF-M, Brussels 2001
Macrolide resistance and treatment failure: Acute otitis media Dagan et.al. AAC 2000, 44: 43-50 • Azithromycin - 10 mg/kg OD for 3 days • S. pneumoniae: 5/17 (29%) failure all 5 ery-resistant (MIC>32) (+ one resistant S. pneu superinfection) NF-M, Brussels 2001
Macrolide resistance and treatment failure: Conclusion • Resistance towards macrolides leading to clinical failure has been reported in • Staphylococci, pneumococci, Gr.A strep., P. acnes, atyp. Mycobacteria, treponemes and Helicobacter • In URTI, skin infections, duodenal ulcer etc. • With erythromycin, clarithromycin and azithromycin NF-M, Brussels 2001
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