Antibiotic susceptibilities and drug resistance in Moraxella (Branhamella) catarrhalis.

PURPOSE

To summarize current knowledge of drug susceptibility and mechanisms of drug resistance in Moraxella (Branhamella) catarrhalis.

MATERIALS AND METHODS

The current medical literature was reviewed, with careful attention to recent studies of the BRO beta-lactamases.

RESULTS

Although intrinsically resistant to a small group of drugs that included vancomycin and trimethoprim, acquired drug resistance in Branhamella catarrhalis was unknown in the early years of antimicrobial therapy. During 1976 to 1977, however, two previously unrecognized beta-lactamases appeared in this species almost simultaneously around the world. At the same time these enzymes, now known as BRO-1 and BRO-2, also appeared in two closely related commensal species of Moraxella. Within four years the BRO enzymes were found in up to 75 percent of B. catarrhalis in the United States where they provide low-level resistance to penicillin and ampicillin but not to most cephalosporins. The BRO genes appear to be chromosomal but are readily transferred by conjugation within the Moraxella genus. Resistance to aminoglycosides and trimethoprim-sulfamethoxazole has been reported from Spain, and resistance to both erythromycin and tetracycline has recently been described among United States isolates of B. catarrhalis.

CONCLUSION

Despite this drug resistance, numerous oral and parenteral agents are available and appear useful for treatment of clinical disease, including amoxicillin/clavulanic acid, erythromycin, the tetracyclines, ciprofloxacin, and trimethoprim/sulfamethoxazole. Recent changes in drug resistance in this species suggest that continued monitoring of drug resistance in B. catarrhalis is needed.