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Macrolide resistance and treatment failure E-mail from Prof. Schito, - - PowerPoint PPT Presentation
Macrolide resistance and treatment failure E-mail from Prof. Schito, - - PowerPoint PPT Presentation
Macrolide resistance and treatment failure E-mail from Prof. Schito, 14-11-01 10:56: for me too these days have been impossible, to the point that I have to decline this invi- tation and pass to you all the responsibility. Sorry for
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Macrolide resistance and treatment failure: Types of studies
Test of develop- ment of R in individual strains
+/- Experimental/analytical prospective
- Eg. Study R-developm. Under ab. Pressure
in vitro similar to in vivo, compare strains + Prospective studies Following strains/clinical evaluation Pre->< during >< Post-study strains (+) if collected
- Retrospective studies
- single cases of failures
- studies of failures (vs. Succ./case contr.)
NF-M, Brussels 2001
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Macrolide resistance and treatment failure: Bacterial species reported
- Actual resistance
- S. aureus
- S. pneumoniae
- S. pyogenes
- P. acnes
- M. kansasii
- T. pallidum
- H. pylori
- MIC > S-conc.:
- H. influenzae
- P. multocida
NF-M, Brussels 2001
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Macrolide resistance and treatment failure: Types of infections
- Otitis media
- Tonsillitis
- Pneumonia
- Skin infections
- Impetigo, Acne
- Dodenal ulcer
- Syphilis
NF-M, Brussels 2001
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Macrolide resistance and treatment failure: Types of infections
Macrolide first choice ?
- Otitis media
no
- Tonsillitis
no
- Pneumonia
no
- Skin infections
- Impetigo, Acne
no
- Dodenal ulcer
no
- Syphilis
no
NF-M, Brussels 2001
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Macrolide resistance and treatment failure: Types of macrolides
Otitis, tonsillitis
- S. pneu., S. pyog.
Azithromycin
Duodenal/ventricular ulcer
- H. pylori
Clarithromycin
Otitis, tonsillitis, impetigo, acne
- S. aureus, S. pneu.,
- S. pyog., P. acnes
Erythromycin Type of infection Bacterial sp. Macrolide
NF-M, Brussels 2001
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Macrolide resistance and treatment failure: Acute otitis media
Dagan et.al. AAC 2000, 44: 43-50
- Azithromycin - 10 mg/kg OD for 3 days
- S. pneumoniae: 5/17 (29%) failure
all 5 ery-resistant (MIC>32) (+ one resistant S. pneu superinfection)
NF-M, Brussels 2001
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Macrolide resistance and treatment failure: Conclusion
- Resistance towards macrolides leading to
clinical failure has been reported in
- Staphylococci, pneumococci, Gr.A strep., P.
acnes, atyp. Mycobacteria, treponemes and Helicobacter
- In URTI, skin infections, duodenal ulcer etc.
- With erythromycin, clarithromycin and