Management of infections in children caused by streptococcus pneumoniae with decreased susceptibility to penicillin

John S. Bradley, Sheldon L. Kaplan, Keith P. Klugman, Robert J. Leggiadro

Research output: Contribution to journalArticlepeer-review

58 Scopus citations


For each clinical scenario several treatment options have been presented by the panel, based on the responding physician's clinical experience, the prevalence of antibiotic resistance in each location and the physicians' assessment of the risk of the infection to the well-being of the child. It is unlikely that randomized, controlled comparative clinical trials with different antibiotic treatment regimens will be performed for each site of infection against antibiotic-resistant pneumococci. These pneumococcal organisms themselves comprise a heterogeneous population with a wide range of susceptibility to penicillin and other beta-lactams and with a high and variable degree of resistance associated with non-beta-lactam antibiotics, previously used as effective alternatives. The authors' approach to therapy of these infections will be tested in clinical experience and will likely evolve as the resistance patterns in S. pneumoniae change in the future. The widespread use of the conjugate pneumococcal vaccines in children should have a dramatic impact on the incidence of invasive pneumococcal disease, similar to the impact of conjugate H. influenzae type b vaccines on invasive Haemophilus disease. Although the new pneumococcal vaccines may reduce the nasopharyngeal carriage of a limited number of pneumococcal serotypes that are represented in the vaccine, the overall impact of the vaccine in preventing mucosal infections such as otitis and sinusitis has yet to be determined. It is likely, however, that the antibiotic-resistant pneumococcus will play a significant role in childhood infections for many years to come.

Original languageEnglish (US)
Pages (from-to)1037-1041
Number of pages5
JournalPediatric Infectious Disease Journal
Issue number12
StatePublished - Dec 1995


  • bacteremia
  • meningitis
  • otitis media
  • penicillin resistance
  • Pneumococcus
  • pneumonia
  • Streptococcus pneumoniae

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Microbiology (medical)


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