Doern G V
Division of Medical Microbiology, Department of Pathology, University of Iowa College of Medicine, Iowa City, IA 52242, USA.
Clin Infect Dis. 2001 Sep 15;33 Suppl 3:S187-92. doi: 10.1086/321847.
The rapid emergence of resistance to antimicrobial agents by Streptococcus pneumoniae in the United States has been influenced by various factors, including the clonal nature of most resistant strains and the fact that organisms with a multiresistant phenotype have become stably endemic. The ease with which transmission occurs and the fact that humans, especially children, are often colonized asymptomatically in the upper respiratory tract have contributed to the problem. Clearly, the most important factor in the emergence of antimicrobial resistance with S. pneumoniae, however, is the selective pressure of antimicrobial agents. Potency, defined as a product of both antibacterial effect and drug delivery, is a key factor. Generally speaking, the more potent an antimicrobial agent, the less likely it is to select for resistance. This is germane to comparisons of oral agents within specific antimicrobial classes (e.g., beta-lactams, macrolides, and fluoroquinolones). Within each class, potencies differ. In view of the existence of stably endemic multidrug-resistant S. pneumoniae, given comparable cost, side-effect profile, palatability, convenience of dosing, and accessibility, use of the most potent agent(s) within a particular class is advocated.
在美国，肺炎链球菌对抗菌药物耐药性的迅速出现受到多种因素影响，包括大多数耐药菌株的克隆性质，以及具有多重耐药表型的菌株已成为稳定的地方流行株这一事实。传播的容易程度以及人类（尤其是儿童）在上呼吸道经常无症状定植这一情况也加剧了该问题。然而，肺炎链球菌抗菌耐药性出现的最重要因素显然是抗菌药物的选择压力。效力，定义为抗菌效果和药物递送的乘积，是一个关键因素。一般来说，抗菌药物效力越强，选择出耐药性的可能性就越小。这与特定抗菌药物类别（如β-内酰胺类、大环内酯类和氟喹诺酮类）中口服药物的比较密切相关。在每个类别中，效力各不相同。鉴于存在稳定的地方流行的多重耐药肺炎链球菌，在成本、副作用特征、口感、给药便利性和可及性相当的情况下，提倡使用特定类别中效力最强的药物。
