Confronting Drug-resistant Pneumococci
Authors: Robert Austrian
Journal: Annals of Internal Medicine (1994)

Editorials15 November 1994Confronting Drug-resistant PneumococciRobert Austrian, MDRobert Austrian, MDUniversity of Pennsylvania School of Medicine, Philadelphia, PA 19104-6088.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-121-10-199411150-00013 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Termed "Captain of the Men of Death" in 1901 by Sir William Osler in the fourth edition of his renowned text, The Principles and Practice of Medicine [1], lobar pneumonia was a dreaded disease in the early years of this century, with case fatality rates from untreated illness of the order of 30% to 35% [2]. Despite significant advances in therapy, first with the introduction of type-specific anticapsular pneumococcal serum, followed a quarter-century later by sulfapyridine and other sulfonamides, it was only after the publication in 1944 of the report of Tillett and colleagues [3] of the treatment of pneumococcal ...References1. Osler W. The Principles and Practice of Medicine. 4th ed. New York: D. Appleton and Company; 1901:108. Google Scholar2. Heffron R. Pneumonia: With Special Reference to Pneumococcus Lobar Pneumonia. Cambridge: Harvard University Press; 1979:656-63. Google Scholar3. Tillett WS, Cambier MJ, McCormack JE. The treatment of lobar pneumonia and pneumococcal empyema with penicillin. Bull N Y Acad. Med. 1944; 20:142-78. Google Scholar4. Bridge RG. The value of bacteriological studies in pneumonia occurring in age group 15-60. Dis Chest. 1956; 30:194-201. Google Scholar5. Morgenroth J, Kaufman M. Arzneifestigkeit bei Bakterien (Pneumokokken). Zeitschr Immunitatsforsch [1]. 1912; 15:610-24. Google Scholar6. Moore HF, Chesney AM. A study of ethylhydrocuprein (optochin) in the treatment of acute lobar pneumonia. Arch Intern Med. 1917; 19:611-82. Google Scholar7. Moore HF, Chesney AM. A further study of ethylhydrocuprein (optochin) in the treatment of acute lobar pneumonia. Arch Intern Med. 1918; 21:659-81. Google Scholar8. Ross RW. Acquired tolerance of pneumococcus to M&B 693. Lancet. 1939;1:1207-8. Google Scholar9. Schmidt LH, Sesler CL. Development of resistance to penicillin by pneumococci. Proc Soc Exp Biol Med. 1943; 52:353-7. Google Scholar10. Eriksen KR. Studies on induced resistance to penicillin in a pneumococcus type I. Acta Path Microbiol Scand. 1945; 22:398-405. Google Scholar11. Kislak JW, Razavi LM, Daly AK, Finland M.Susceptibility of pneumococci to nine antibiotics. Am J Med Sci. 1965; 250:261-8. Google Scholar12. Hansman D, Bullen M. A resistant pneumococcus. Lancet. 1967; 2:264-5. Google Scholar13. Branham S. The effect of sulfapyridine and sulfanilamide with and without serum in experimental meningococcal infection. Public Health Rep. 1940; 55:12-25. Google Scholar14. Gauld JR, Nitz RE, Hunter DH, Rust H, Gauld RL.Epidemiology of meningococcal meningitis at Fort Ord. Am J Epidemiol. 1965; 82:56-72. Google Scholar15. Hakenbeck R, Tarpay M, Tomasz A. Multiple changes of penicillin-binding proteins in penicillin-resistant clinical isolates of Streptococcus pneumoniae. Antimicrob Agents Chemother. 1980; 17:364-71. Google Scholar16. Laible G, Spratt BG, Hakenbeck R. Interspecies recombinational events during the evolution of altered PBP 2x genes in penicillin-resistant clinical isolates of Streptococcus pneumoniae. Mol Microbiol. 1991; 5:1993-2002. Google Scholar17. Hotchkiss RD. Transfer of penicillin resistance in pneumococci by the deoxyribonucleate derived from resistant cultures. Cold Spring Harbor Symp Quant Biol. 1952; 16:457-61. Google Scholar18. Shockley TE, Hotchkiss RD. Stepwise introduction of transformable penicillin resistance in Pneumococcus. Genetics. 1970; 64:397-408. Google Scholar19. Soares S, Kristinsson KG, Musser JM, Tomasz A. Evidence for the introduction of a multiresistant clone of serotype 6B Streptococcus pneumoniae from Spain to Iceland in the late 1980s. J Infect Dis. 1993; 168:158-63. Google Scholar20. Klugman KP. Pneumococcal resistance to antibiotics. Clin Microbiol Rev. 1990; 3:171-96. Google Scholar21. Gunnison JB, Fraher MA, Pelcher EA, Jawetz E.Penicillin-resistant variants of pneumococci. Appl Microbiol. 1968; 16:311-4. Google Scholar22. Jacobs MR, Koornhof HJ, Robins-Browne RM, Stevenson CM, Vermaak ZA, Freiman I, et al. Emergence of multiply resistant pneumococci. N Engl J Med. 1978; 299:735-40. Google Scholar23. Alonso J, Madrigal V, Garcia-Fuentes M. Recurrent meningitis from a multiply resistant Streptococcus pneumoniae strain treated with erythromycin (Letter). Pediatr Infect Dis J. 1991; 10:256. Google Scholar24. Appelbaum PC. Antimicrobial resistance in Streptococcus pneumoniae: an overview. Clin Infect Dis. 1992; 15:77-83. Google Scholar25. Casal J, Fenoll A, Vicioso MD, Munoz R. Increase in resistance to penicillin in pneumococci in Spain (Letter). Lancet. 1989; 1:735. Google Scholar26. Butler JC, Breiman RF, Facklam RR. Emergence of drug-resistant pneumococci in the United States. In: Program and Abstracts of the 33rd Interscience Conference on Antimicrobial Agents and Chemotherapy. Oct. 23, 1993, New Orleans, LA. Google Scholar27. Centers for Disease Control and Prevention.Drug-resistant Streptococcus pneumoniae—Kentucky and Tennessee, 1991. MMWR Morb Moral Wkly Rep. 1994; 43:23-6, 31. Google Scholar28. Klugman KP, Koornhof HJ, Kuhnle V. Clinical and nasopharyngeal isolates of unusual multiply resistant pneumococci. Am J Dis Child. 1986; 140:1186-90. Google Scholar29. Lund E, Rasmussen P. Omni-serum. A diagnostic Pneumococcus serum, reacting with the 82 known types of pneumococcus. Acta Pathol Microbiol Scand. 1966; 68:458-60. Google Scholar30. Tucker HA, Eagle H. Serum concentrations of penicillin G in man following intramuscular injections in aqueous solution and in peanut oil-beeswax suspension. Am J Med. 1948; 4:343-54. Google Scholar31. Eagle H. Speculations as to the therapeutic significance of the penicillin blood level. Ann Intern Med. 1948; 28:260-77. Google Scholar32. Pallares R, Gudiol F, Linares J, Ariza J, Rufi G, Murgui L, et al. Risk factors and response to antibiotic therapy in adults with bacteremic pneumonia caused by penicillin-resistant pneumococci. N Engl J Med. 1987; 317:18-22. Google Scholar33. Figueiredo AM, Connor JD, Severin A, vaz Pato MV, Tomasz A. A pneumococcal clinical isolate with high-level resistance to cefotaxime and ceftriazone. Antimicrob Agents Chemother. 1922; 36:886-9. Google Scholar34. John CC. Treatment failure with use of a third-generation cephalosporin for penicillin-resistant pneumococcal meningitis: case report and review. Clin Infect Dis. 1994; 18:188-93. Google Scholar35. Viladrich PF, Gudiol F, Linares J, Rufi G, Ariza J, Pallares R. Characteristics and antibiotic therapy of adult meningitis due to penicillin-resistant pneumococci. Am J Med. 1988; 84:839-46. Google Scholar36. Viladrich PF, Gudiol F, Linares J, Pallares R, Sabate I, Rufi G, et al. Evaluation of vancomycin for therapy of adult pneumococcal meningitis. Antimicrob Agents Chemother. 1991; 35:2467-72. Google Scholar37. Butler JC, Breiman RF, Campbell JF, Lipman HB, Broome CV, Facklam RR. Pneumococcal polysaccharide vaccine efficacy. An evaluation of current recommendations. JAMA. 1993; 270:1826-31. Google Scholar38. MacLeod CM, Hodges RG, Heidelberger M, Bernhard WG.Prevention of pneumococcal pneumonia by immunization with specific capsular polysaccharides. J Exp Med. 1945; 82:445-65. Google Scholar39. Sivonen A. Effect of Neisseria meningitis group A polysaccharide vaccine on nasopharyngeal carrier rates. J Infect. 1981; 3:266-72. Google Scholar40. Mohle-Boetani JC, Ajello G, Breneman E, Deaver KA, Harvey C, Plikaytis BD, et al. Carriage of Haemophilus influenzae type b in children after widespread vaccination with conjugate Haemophilus influenzae type b vaccines. Pediatr Infect Dis J. 1993; 12:589-93. Google Scholar41. Vella PP, Marburg S, Staub JM, Kniskern PJ, Miller W, Hagopian A, et al. Immunogenicity of conjugate vaccines consisting of pneumococcal capsular types 6B, 14, 19F, and 23F and a meningococcal outer membrane protein complex. Infect Immun. 1992; 60:4977-83. Google Scholar Author, Article, and Disclosure InformationAffiliations: University of Pennsylvania School of Medicine, Philadelphia, PA 19104-6088.Corresponding Author: Robert Austrian, MD, Department of Molecular and Cellular Engineering, 331 Johnson Pavilion, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-6088. 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