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A Fresh Look at the Definition of Susceptibility of Streptococcus pneumoniae to  -Lactam Antibiotics
Daniel M. Musher, MD;
John G. Bartlett, MD;
Gary V. Doern, MD
Arch Intern Med. 2001;161:2538-2544.
Definitions for susceptibility or resistance of Streptococcus
pneumoniae to penicillin were not developed until penicillin-resistant
pneumococci appeared in South Africa in the late 1970s. The definition that
was accepted (which still remains in use) and later definitions of resistance
to most other  -lactam antibiotics were derived from laboratory and clinical
data relating to the treatment of meningitis, not otitis media, sinusitis,
or pneumonia. An understanding of the origin of these definitions helps to
resolve the apparent paradox that infections of the respiratory tract due
to seemingly -lactam–resistant pneumococci may still respond well
to standard doses of these drugs. A recently sanctioned change in the definition
of susceptibility to amoxicillin is helpful in eliminating the paradox for
this drug, but it may create further confusion by implying that, on a microgram
basis, amoxicillin is substantially more effective than penicillin or third-generation
cephalosporins. This article examines definitions of susceptibility and resistance
of pneumococci, highlighting areas that have led to confusion and proposing
a new way of understanding them.
From the Veterans Affairs Medical Center and the Departments of Medicine
and Molecular Virology and Microbiology, Baylor College of Medicine, Houston,
Tex (Dr Musher); the Department of Medicine, Johns Hopkins Medical School,
Baltimore, Md (Dr Bartlett); and the Department of Microbiology, University
of Iowa Hospitals and Clinics, Iowa City (Dr Doern).
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Alou et al.
J Antimicrob Chemother 2005;55:742-747.
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