[Problems of resistance in Streptococcus pneumoniae].

Penicillin-resistant pneumococci are an increasing worldwide problem that until now has spared the Netherlands and a small number of other European countries. In countries with resistant pneumococci empirical therapy of otitis media and of meningitis is difficult. Special antibiotics such as clindamycin and ceftriaxone may be needed or combinations of vancomycin and high doses of cephalosporin. In spite of antibiotic resistance pneumococcal pneumonia can be treated successfully with high doses of benzylpenicillin or cephalosporin. In case of an infection outside the central nervous system, it is not clear what level of minimal inhibitory concentration indicates that therapy will fail, probably > 4 mg/l. Even in regions with much resistance such levels are rare. It is fortunate that antibiotic resistance only occurs in a limited number of pneumococcal strains, which in addition happen to be included in antipneumococcal vaccines.