tetracycline and Pneumonia--Pneumococcal

Streptococcus pneumoniae is an important pathogen in many community-acquired respiratory infections in the United States and a leading cause of morbidity and mortality worldwide. Unfortunately, S. pneumoniae is becoming increasingly resistant to a variety of antibiotics. Results of recent surveillance studies in the United States show that the prevalence of penicillin-nonsusceptible S. pneumoniae ranges from 25% to >50%, and rates of macrolide resistance among pneumococci are reported to be as high as 31%. A high prevalence of resistance to other antimicrobial classes is found among penicillin-resistant strains. Newer quinolones (e.g., gatifloxacin, gemifloxacin, and moxifloxacin) that have better antipneumococcal activity in vitro are the most active agents and therefore are attractive options for treatment of adults with community-acquired respiratory infections. Efforts should be made to prevent pneumococcal infections in high-risk patients through vaccination.

Topics: 4-Quinolones; Anti-Bacterial Agents; Anti-Infective Agents; Drug Resistance; Drug Resistance, Multiple; Gene Frequency; Humans; Macrolides; Microbial Sensitivity Tests; Pneumococcal Vaccines; Pneumonia, Pneumococcal; Streptococcus pneumoniae; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

During the last few years, acquired resistance of pneumococci to the main families of normally active antibiotics has appeared. This resistance is now worldwide but unevenly distributed: in Europe, for instance, it predominates in Spain and Hungary. In France, according to the national Registry, resistance to penicillins, which was less than 5 percent in 1988, rose to 16.9 percent in 1991. More than 80 percent of resistant strains are found among 4 stereotypes (6, 9, 19, 23) and more than 50 percent belong to stereotype 23F exclusively. The incidence of penicillin-resistant has been evaluated at 8.5 percent in the year 1991-92. The most significant risk factor is a previous treatment with beta-lactam antibiotics, but some authors also blame frequent pneumonias in the previous year, nosocomial pneumonia, or hospitalization during the previous 3 months. There are no specific clinico-radiological features. The incidence of resistant strains is said to be higher in HIV seropositive subjects. Amoxicillin administered in high doses remains the reference treatment for strains with intermediate susceptibility (minimal inhibitory concentration [MIC] between 0.1 and 1.0 microgram/ml). Strains with a more than 1 microgram/ml MIC require beta-lactam antibiotics such as ceftriaxone, cefotaxime of imipenem in high doses. Pristinamycin still has good in vitro activity on resistant strains. Prevention rests on isolation of infected patients, treatment of healthy carriers and wide prescription of anti-pneumococcus vaccine.

Topics: Acquired Immunodeficiency Syndrome; AIDS-Related Opportunistic Infections; Amoxicillin; Anti-Bacterial Agents; Drug Resistance, Microbial; Humans; Incidence; Penicillin G; Penicillin Resistance; Pneumonia, Pneumococcal; Streptococcus pneumoniae; Tetracycline; Tetracycline Resistance

Topics: Chlamydia Infections; Chlamydophila psittaci; Humans; Meningococcal Infections; Mycoplasma Infections; Penicillins; Pneumonia; Pneumonia, Pneumococcal; Pneumonia, Staphylococcal; Pneumonia, Viral; Tetracycline

Topics: Anti-Bacterial Agents; Bronchopneumonia; Child; Chloramphenicol; Erythromycin; Humans; Penicillins; Pneumonia, Pneumococcal; Sulfonamides; Tetracycline

The MIC90 of glycylcycline (< or =0.06 mg/L) against 55 strains of Streptococcus pneumoniae was 100-fold lower than that of minocycline or tetracycline. In a mouse model of penicillin-resistant S. pneumoniae (PRSP) pneumonia, glycylcycline (10 mg/kg) decreased bacterial counts in the lungs from 10(6) cfu to <10(2) cfu, whereas no apparent reduction of bacterial numbers was observed with minocycline or penicillin G. Pharmacokinetic studies showed that the half-life and area under the curve of glycylcycline were superior to those of minocycline and penicillin G in the lungs. These results show a preferential distribution of glycylcycline in the lungs and potent in vivo bactericidal activity in PRSP pneumonia.

Topics: Animals; Anti-Bacterial Agents; Disease Models, Animal; Female; Lung; Mice; Mice, Inbred CBA; Microbial Sensitivity Tests; Minocycline; Penicillin G; Penicillins; Pneumonia, Pneumococcal; Streptococcus pneumoniae; Tetracycline

Topics: Child, Preschool; Clindamycin; Drug Combinations; Erythromycin; Humans; Infant; Male; Meningitis, Pneumococcal; Middle Aged; Penicillin G; Penicillin Resistance; Pneumonia, Pneumococcal; Streptococcus pneumoniae; Sulfamethoxazole; Tetracycline; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

This study examined the resistance to penicillin, tetracycline, erythromycin, and chloramphenicol of 318 pneumococcal strains isolated in Spanish hospitals from blood or cerebrospinal fluid of patients during 1979 to 1981. The serotypes of these strains were determined to discover whether a correlation between serotype and patterns of antibiotic resistance could be found. Seven and nine patterns of resistance were found in strains isolated from blood and cerebrospinal fluid, respectively; tetracycline was the most frequent pattern, followed by tetracycline associated with chloramphenicol. A random distribution of serotypes which was similar to the general distribution of serotypes was found for resistance to tetracycline and chloramphenicol, but penicillin-resistant strains were confined to seven serotypes. Thirty-six strains of penicillin-resistant pneumococci isolated from sources other than blood or cerebrospinal fluid were also serotyped. They represented the same serotypes, suggesting that serotype distribution among penicillin-resistant strains could be a manifestation of local epidemiological factors.

Topics: Chloramphenicol; Drug Resistance, Microbial; Erythromycin; Humans; In Vitro Techniques; Meningitis, Pneumococcal; Penicillin Resistance; Pneumonia, Pneumococcal; Spain; Species Specificity; Streptococcus pneumoniae; Tetracycline

Despite modern antibiotic therapies, pneumococcal pneumonia still remains a serious epidemiologic problem. Some 25% of pneumococcal pneumonias are accompanied by bacteremia. The mortality rate in these forms is some 17%, and in patients above 50 it is as high as 28%. Early toxic injury is responsible for the high mortality rate, which is as high as 13,000-60,000 deaths every year in the USA. Several resistant strains of pneumococci have recently been discovered, and for all these reasons research into active immunization against pneumococci has been resumed. A vaccine is now available which consists of polysaccharide antigens of the 14 most important serotypes and confers a protection rate of some 80% against pneumococcal pneumonia. Vaccination is recommended for elderly and debilitated persons in particular.

Topics: Antibodies, Bacterial; Bacterial Vaccines; Erythromycin; Humans; Penicillin Resistance; Penicillins; Pneumonia, Pneumococcal; Sepsis; Streptococcus pneumoniae; Tetracycline

Annualy in the USA, the estimated occurence of pneumococcal disease exceeds 500 000 cases of pneumonia (50 000 deaths), 1 200 000 cases of otitis media and 5 000 cases of meningitis. The pneumococcus remains the single most important pathogen which can cause pneumonia. When bacteremia accompanied pneumococcal pneumonia (one-fifth of these), the case fatality rate is approximately of 25% and exceeds 50% in individuals over 50 years of age. Most of the deaths (60%) occur within the first five days of illnesses, despite prompt antibiotic treatment of these patients. Emergence of pneumococcal strains with diminished sensitivity for penicillin, or resistant to tetracycline and other antibiotics is also a factor which lend increasing support to the concept that high risk patients should be protected from pneumococcal infection by immunoprophylaxis. A change of capsular types associated with bacteriemic disease has occured, in the USA, during the past three decades. The types 1 and 3 are less common than in the pre-antibiotic era, and the types 4, 8, 12, and 14 have become more prevalent. Infections with type 2, an epidemic type, have occured infrequently in the past 20 years. In the USA, at the present time, nearly four-fifths of bacteremic cases are associated with only 14 of the 84 pneumococcal capsular type ; in descending frequency : 8, 4, 1, 14, 3, 51, 12, 6, 56, 9, 19, 23, 5 and 20 (American system of nomenclature). The predominant capsular types of otitis media are : 1, 3, 6, 7, 14, 18 and 23. The polyvalent pneumococcal polysaccharide vaccine newly developed in the USA, is safe, antigenic and effective. Its widespread use can be expected to reduce the number of deaths attribuable to pneumococcal bacteremia.

Topics: Adolescent; Adult; Aged; Humans; Immunotherapy; Middle Aged; Penicillin Resistance; Penicillins; Pneumococcal Infections; Pneumonia, Pneumococcal; Sepsis; Tetracycline; United States

We studied the bactericidal capacity of the rat lung during the development of pneumococcal pneumonia. Pneumonia was produced in a lower lobe by the intrabronchial instillation of 10(4)Streptococcus pneumoniae cells in buffer. Lung bacterial counts progressively increased, reaching 10(7) per lung within 48 h, and the increase was associated with localized atelectasis and consolidation. Bacterial multiplication was inhibited with tetracycline at various intervals after infection, and the subsequent clearance of pneumococci was determined. Viable pneumococci were rapidly killed by lung defenses if bacterial multiplication was inhibited within 12 h of the onset of infection. No change occurred in the bacterial populationif tetracycline was delayed until 24 h after infection, indicating that pneumococcal killing by lung defenses had ceased. This effect could be reproduced with the addition of pneumococcal capsular polysaccharide to the inoculum, which produced a dose-related inhibition of pneumococcal clearance. The clearance of S. epidermidis was not impaired in the presence of pneumococcal pneumonia or by administration of exogenous capsular polysaccharide. These data indicate that pneumococcal pneumonia causes a marked impairment in lung antipneumococcal defenses within 24 h of the onset of infection. This acquired defect in antibacterial defenses may be due to the accumulation of pneumococcal capsular material in the lungs of infected animals.

Topics: Animals; Lung; Male; Mice; Phagocytosis; Pneumonia, Pneumococcal; Polysaccharides, Bacterial; Staphylococcus; Streptococcus pneumoniae; Tetracycline; Time Factors

Topics: Adolescent; Anti-Bacterial Agents; Blood Cells; Blood Sedimentation; Chloramphenicol; Clinical Laboratory Techniques; Diagnosis; Drug Therapy; Erythromycin; Geriatrics; Mortality; Penicillins; Pneumonia; Pneumonia, Pneumococcal; Radiography, Thoracic; Spiramycin; Sputum; Tetracycline

Topics: Drug Resistance; Drug Resistance, Microbial; Humans; Pneumococcal Infections; Pneumonia; Pneumonia, Pneumococcal; Tetracycline

Topics: Bacteremia; Bacteriological Techniques; Chloramphenicol; Drug Therapy; Erythromycin; Immunization, Passive; Klebsiella; Leukocyte Count; New York; Penicillins; Pneumococcal Infections; Pneumonia; Pneumonia, Pneumococcal; Sepsis; Statistics as Topic; Streptococcal Infections; Streptomycin; Tetracycline

Topics: Anti-Bacterial Agents; Biomedical Research; Bronchiectasis; Bronchitis; Bronchitis, Chronic; Drug Tolerance; Lymecycline; Pneumonia; Pneumonia, Pneumococcal; Sputum; Statistics as Topic; Tetracycline; Toxicology

Topics: Anti-Bacterial Agents; Drug Therapy; Erythromycin; Humans; Lung Diseases; Lung Diseases, Fungal; Penicillins; Pneumonia; Pneumonia, Pneumococcal; Pneumonia, Rickettsial; Pneumonia, Viral; Streptomycin; Tetracycline; Tuberculosis

Topics: Anti-Bacterial Agents; Erythromycin; Humans; Penicillins; Peptide Hydrolases; Pneumonia; Pneumonia, Pneumococcal; Tetracycline

Topics: Anti-Bacterial Agents; Biomedical Research; Methylprednisolone; Pneumonia; Pneumonia, Pneumococcal; Prednisolone; Research Design; Tetracycline

Topics: Anti-Bacterial Agents; Bronchopneumonia; Kidney Diseases; Penicillins; Pneumonia; Pneumonia, Pneumococcal; Sulfonamides; Tetracycline

Topics: Anti-Bacterial Agents; Penicillins; Pneumonia; Pneumonia, Pneumococcal; Tetracycline

Topics: Anti-Bacterial Agents; Pneumonia; Pneumonia, Pneumococcal; Protein Synthesis Inhibitors; Tetracycline