New strategies to overcome antimicrobial resistance in Streptococcus pneumoniae with beta-lactam antibiotics.

The worldwide epidemic of antibiotic resistance in Streptococcus pneumoniae appears to advance inexorably and the measures taken to date to contain its progression have not been successful. Consideration should be given to the complex relationship between antibiotic consumption and resistance to the drug administered and also to other agents in the same and other antibiotic groups. We propose an integrated triple strategy that maximizes the use of the current antibiotic arsenal and is designed to curb the spread of resistance in S. pneumoniae. There are three main parts to this strategy: (i) reduction of prescribing, with particular emphasis on those drugs whose consumption has been shown to correlate strongly with resistance; (ii) development of new formulations or dosing schedules of those drugs whose pharmacodynamic parameters are better suited to cope with highly resistant strains; and (iii) encouragement of the use of antibiotics with the maximal capability of bacterial eradication. We believe such a strategy would reduce the spread of resistance both in the current ecological situation and in the post-pneumococcal vaccination era to come. Of all current antibiotics amoxicillin meets the above requirements, and seems to be the least ecologically disturbing oral antibiotic with regard to resistance in S. pneumoniae.