Strategies and options for minimizing resistance emergence in pulmonary infections.

The early-onset hospital pulmonary gram-negative infections may respond to ciprofloxacin and co-amoxiclav without significant resistance development. Penicillin-resistant Streptococcus pneumoniae may be treated with macrolides, fluoroquinolones, and glycopeptides. The late-onset hospital pathogens all seem to have developed resistance to cephalosporins, so greater reliance is now made on the fluoroquinolones and carbapenems when aminoglycoside therapy is considered undesirable.