Multiply-resistant pneumococcus: therapeutic problems in the management of serious infections.

The control of penicillin-resistant pneumococci has become one of the more serious therapeutic challenges facing clinicians today. The occurrence and geographical coverage of these microorganisms have increased rapidly since they were first recognized in the late 1960s. They have now been reported from every continent, and in some regions can account for over 60% of the pneumococci isolated. An even greater concern is the propensity of penicillin-resistant pneumococci towards resistance to multiple antibiotics, including the cephalosporins and non-beta-lactam drugs. In areas where multiply-resistant strains are common, the therapeutic choices for the treatment of life-threatening infections may be limited to drugs which are either toxic for the patient or for which we are only beginning to gain clinical experience. As the importance of Streptococcus pneumoniae in meningitis continues to increase and multiply-resistant strains become more widespread and entrenched, it is essential that the search for more well-tolerated and effective treatment regimens continues. However, unless the effect of antibiotics on the selection of these resistant pathogens is addressed and a more judicious approach towards drug use is taken; this resistance problem will continue well into the future.