Susceptibility of pneumococci to 14 beta-lactam agents: comparison of strains resistant, intermediate-resistant, and susceptible to penicillin.

To measure the susceptibility of penicillin-resistant pneumococci to newer beta-lactam agents, we evaluated 54 selected strains recovered from patients with bacteremia or meningitis. Three groups of pneumococci were tested: penicillin-susceptible strains, strains with intermediate penicillin resistance, and penicillin-resistant strains. Minimal inhibitory concentrations of benzyl penicillin, oxacillin, cephalothin, cefamandole, cefoxitin, moxalactam (LY127935), cefotaxime (HR756), piperacillin, pirbenicillin, N-formimidoyl thienamycin (MK0787), cefoperazone (T1551), mezlocillin, azlocillin, and mecillinam were determined. For all groups of pneumococci tested, cefotaxime, and particularly thienamycin, had the greatest activity. Piperacillin, mezlocillin, and azlocillin had activity similar to that of benzyl penicillin. Cefoperazone had less activity than penicillin against strains with penicillin minimal inhibitory concentrations of less than 1 microgram/ml but greater activity than penicillin against strains with greater resistance. Oxacillin, cephalothin, cefamandole, and pirbenicillin all had less activity for each group of pneumococci tested; moxalactam, cefoxitin, and mecillinam had the least activity. The relative differences in susceptibility to penicillin of each group of pneumococci tested were similar for each of the beta-lactam agents tested. The clinical effectiveness of cefotaxime and thienamycin for therapy of disease due to penicillin-resistant pneumococci needs further evaluation, and of particular interest will be the levels of these drugs which can be achieved in cerebrospinal fluid.