Susceptibilities of Streptococcus pneumoniae and Haemophilus influenzae to 10 Oral Antimicrobial Agents Based on Pharmacodynamic Parameters: 1997 U.S. Surveillance Study

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Antimicrobial Agents and Chemotherapy, August 1999, p. 1901-1908, Vol. 43, No. 8
0066-4804/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.

Susceptibilities of Streptococcus pneumoniae and Haemophilus influenzae to 10 Oral Antimicrobial Agents Based on Pharmacodynamic Parameters: 1997 U.S. Surveillance Study

Michael R. Jacobs,¹^,^* Saralee Bajaksouzian,¹ Anne Zilles,¹ Gengrong Lin,² Glenn A. Pankuch,² and Peter C. Appelbaum²

Department of Pathology, Case Western Reserve University and University Hospitals of Cleveland, Cleveland, Ohio 44106,¹ and Department of Pathology, Hershey Medical Center, Hershey, Pennsylvania 17033²

Received 20 August 1998/Returned for modification 31 January 1999/Accepted 25 May 1999

The susceptibilities of Streptococcus pneumoniae (1,476 strains) and untypeable Haemophilus influenzae (1,676 strains) tovarious oral $beta$ -lactam, macrolide-azalide, and fluoroquinoloneantimicrobial agents were determined by broth microdilution. Organismswere isolated from specimens obtained from outpatients in sixgeographic regions of the United States. MIC data were interpretedaccording to pharmacodynamically derived breakpoints applicableto the oral agents tested. Among H. influenzae strains, 41.6%were $beta$ -lactamase positive. Virtually all H. influenzae strainswere susceptible to amoxicillin-clavulanate (98%), cefixime (100%),and ciprofloxacin (100%), while 78% were susceptible to cefuroxime,57% were susceptible to amoxicillin, 14% were susceptible to cefprozil,9% were susceptible to loracarbef, 2% were susceptible to cefaclor,and 0% were susceptible to azithromycin and clarithromycin. AmongS. pneumoniae isolates, 49.6% were penicillin susceptible, 17.9%were intermediate, and 32.5% were penicillin resistant, with penicillinMICs for 50 and 90% of the isolates tested of 0.12 and 4 µg/ml,respectively. Overall, 94% of S. pneumoniae isolates were susceptibleto amoxicillin and amoxicillin-clavulanate, 69% were susceptibleto azithromycin and clarithromycin, 63% were susceptible to cefproziland cefuroxime, 52% were susceptible to cefixime, 22% were susceptibleto cefaclor, and 11% were susceptible to loracarbef. Althoughciprofloxacin has marginal activity against S. pneumoniae, nohigh-level fluoroquinolone-resistant strains were found. Significantcross-resistance was found between penicillin and macrolides-azalidesamong S. pneumoniae isolates, with 5% of the penicillin-susceptiblestrains being macrolide-azalide resistant, compared with 37% ofthe intermediate isolates and 66% of the resistant isolates. Resistancewas highest in S. pneumoniae isolates from patients younger than10 years of age, middle ear and paranasal sinus specimens, andthe southern half of the United States. With the continuing risein resistance, judicious use of oral antimicrobial agents is necessaryin all agegroups.

^* Corresponding author. Mailing address: University Hospitals of Cleveland, 11100 Euclid Ave., Cleveland, OH 44106. Phone: (216)844-3484. Fax: (216) 844-5601. E-mail: mrj6{at}po.cwru.edu.

Antimicrobial Agents and Chemotherapy, August 1999, p. 1901-1908, Vol. 43, No. 8
0066-4804/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.

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