Doern G V
Clinical Microbiology Laboratories, University of Iowa Hospitals and Clinics and University of Iowa College of Medicine, Iowa City 52242, USA.
Semin Respir Crit Care Med. 2000;21(4):273-84. doi: 10.1055/s-2000-9863.
Among antimicrobial agents that have consistently been efficacious in treating infections due to specific bacteria over extended periods of time, there are few better examples than Streptococcus pneumoniae and penicillin. Until recently in the United States (U.S.), this combination had remained nearly uniformly effective. The sole issue mitigating for or against use of penicillin (or ampicillin) in the management of systemic pneumococcal infections, or oral ampicillin (or amoxicillin) in treating localized, nonlife-threatening pneumococcal infections, was the penicillin allergy status of the patient. In the nonallergic patient, penicillin or its congeners, have been the drugs of choice largely because resistance to these agents remained uncommon. All of that changed dramatically in the U.S. during the early part of the decade of the 1990s with the emergence of high rates of antimicrobial resistance with S. pneumoniae, and concomitantly, the recognition of diminished efficacy when certain other antimicrobials were used to treat pneumococcal infections. The intent of this discussion is to address a variety of specific issues that pertain to the problem of antimicrobial resistance with S. pneumoniae. The format chosen is a selection of the most asked questions regarding S. pneumoniae and antimicrobial resistance, and then answers are provided.
在长期以来一直有效治疗特定细菌感染的抗菌药物中，很少有比肺炎链球菌和青霉素更好的例子了。直到最近在美国，这种组合几乎一直都有效。在全身性肺炎球菌感染的治疗中，支持或反对使用青霉素（或氨苄西林），以及在治疗局部、非危及生命的肺炎球菌感染时支持或反对使用口服氨苄西林（或阿莫西林）的唯一问题，是患者的青霉素过敏状态。在无过敏的患者中，青霉素或其同类物一直是首选药物，主要是因为对这些药物的耐药性仍然不常见。20世纪90年代初，在美国所有这一切都发生了巨大变化，随着肺炎链球菌出现高比例的抗菌药物耐药性，同时，人们认识到使用某些其他抗菌药物治疗肺炎球菌感染时疗效降低。本次讨论的目的是解决与肺炎链球菌抗菌药物耐药性问题相关的各种具体问题。所选择的形式是一系列关于肺炎链球菌和抗菌药物耐药性的最常见问题，然后给出答案。
