Article information
En los últimos años se ha producido un aumento significativo en la prevalencia de resistencias de los principales patógenos respiratorios a la mayoría de los antibióticos utilizados en el ámbito extrahospitalario que ha comprometido en muchos casos el tratamiento empírico de algunas infecciones respiratorias, siendo de especial interés el progresivo aumento de las tasas de resistencia deStreptococcus pneumoniae a macrólidos y penicilina y deS. pyogenes a macrólidos
Varios estudios han confirmado la asociación entre consumo de antibióticos y desarrollo de resistencia en S. pneumoniae y S. pyogenes. Sin embargo, ni todos los antibióticos tienen la misma capacidad de selección de resistencias, ni todos se ven afectados de la misma manera
El objetivo del tratamiento antimicrobiano en las infecciones del tracto respiratorio es la erradicación bacteriológica. Los parámetros farmacodinámicos pueden utilizarse para predecir la erradicación bacteriológica de los antimicrobianos
Palabras clave:
Erradicación
Infección respiratoria
S. pneumoniae
S. pyogenes
Farmacodinámica
During the last few years, increasing antibiotic resistance amongst the major respiratory pathogens in the community has compromised the choice of empirical therapy for some respiratory tract infections. Of special interest has been the progressive increase in the resistance rates of Streptococcus pneumoniaeto macrolides and penicillin, and of S. pyogenes to macrolides
Several studies have confirmed the association between community use of certain antibiotics and the development of resistance inS. pneumoniae and S. pyogenes. Nevertheless, not all the antibiotics have the same ability to select resistance and not all microorganisms are affected in the same way
The aim of antimicrobial therapy in respiratory tract infections is bacterial eradication. Pharmacokinetic and pharmacodynamics can be used to predict bacteriological eradication with antimicrobial therapy
Keywords:
Eradication
Respiratory tract infection
S. pneumoniae
S. pyogenes
Pharmacodynamics
Full text is only aviable in PDF
Bibliografía
[1.]
J. Romero Vivas, M. Ruiz Alonso, O. Corral, S. Pacheco, E. Agudo, J.J. Picazo.
Estudio de las infecciones respiratorias extrahospitalarias.
Enferm Infecc Microbiol Clin, 15 (1997), pp. 289-298
[2.]
Asociación Española de Pediatría.
Sección de Pediatría Extrahospitalaria. Estudio del contenido de la consulta en pediatría extrahospitalaria.
pp. 21
[3.]
C. Ochoa, L. Inglada, J.M. Eiros, G. Solís, A. Vallano, L. Guerra.
Spanish Study Group on Antibiotic Treatment. Appropiateness of antibiotic prescriptions in community-acquired acute pediatric respiratory infections in Spanish emergency rooms.
Pediatr Infect Dis J, 20 (2001), pp. 751-758
[4.]
P. Huovinen, O. Cars.
Control of antimicrobial resistance: time for action.
Bmj, 317 (1998), pp. 613-614
[5.]
J.J. Granizo, L. Aguilar, J. Casal, C. García-Rey, R. Dal-Rè, F. Baquero.
Streptococcus pneumoniae resistance to erythromycin and penicillin in relation to macrolide and β-lactam consumption in Spain.
J Antimicrob Chemother, 46 (2000), pp. 767-773
[6.]
A. Fenoll, C. Martín-Bourgón, R. Muñoz, D. Vicioso, J. Casal.
Serotype distribution and antimicrobial resistance of Streptococcus pneumoniae isolates causing systemic infections in Spain, 1979–1989.
Rev Infect Dis, 13 (1991), pp. 56-60
[7.]
J.J. Granizo, L. Aguilar, J. Casal, R. Dal-Ré, F. Baquero.
Streptococcus pyogenes resistance to erythromycin in relation to macrolide consumption in Spain (1986–1997).
J Antimicrob Chemother, 46 (2000), pp. 959-964
[8.]
C.D. Marchant, S.A. Carlin, C.E. Johnson, P.A. Shurin.
Measuring the comparative efficacy of antibacterial agents for acute otitis media: The "Pollyanna phenomenon".
J Pediatr, 120 (1992), pp. 72-77
[9.]
J. Garau.
Treatment of drug-resistant pneumococcal pneumonia.
Lancet Infect Dis, 2 (2002), pp. 404-415
[10.]
D. Nicolau.
Clinical and economic implications of antimicrobial resistance for the management of community-acquired respiratory tract infections.
J Antimicrob Chemother, 50 (2002), pp. 61-70
[11.]
J.A. Karlowsky, C. Thornsberry, M.E. Jones, A.T. Evangelista, I.A. Critchley, D.F. Sahm.
Factors associated with relative rates of antimicrobial resistance among Streptococcus pneumoniae in the United States: Results from the TRUST surveillance program (1998–2002).
Clin Infect Dis, 36 (2003), pp. 963-970
[12.]
Centers for Disease Control and Prevention.
Preventing pneumococcal disease among infants and young children: Recommendations of the Advisory Committee on Immunization Practices (ACIP).
Mmwr, 49 (2000), pp. 1-35
[13.]
E. Pérez-Trallero, C. Fernández-Mazarrasa, C. García-Rey, E. Bouza, L. Aguilar, J. García de Lomas, et al.
and Spanish Surveillance Group for Respiratory Pathogens. Antimicrobial susceptibilities of 1,684 Streptococcus pneumoniae and 2,039 Streptococcus pyogenes isolates and their ecological relationships: results of a 1-year (1998–1999) multicenter surveillance study in Spain.
Antimicrob Agents Chemother, 45 (2001), pp. 3334-3340
[14.]
L. Aguilar, C. García-Rey, M.J. Giménez.
Presión antibiótica, desarrollo de resistencias en Streptococcus pneumoniae y fracaso clínico: un círculo no tan vicioso para algunos antibióticos.
Rev Esp Quimioterap, 14 (2001), pp. 17-21
[15.]
L. Aguilar, M.J. Giménez, C. García-Rey, J.E. Martín.
Strategies to overcome antimicrobial resistance in Streptococcus pneumoniae with β-lactam antibiotics.
J Antimicrob Chemother, 50 (2002), pp. 93-100
[16.]
J. García de Lomas, L. López Cerezo.
Gimeno Cardona y Grupo Español para la Vigilancia de los Patógenos Respiratorios (GEVIPAR). Sensibilidad de los patógenos respiratorios en la comunidad de España: resultados del estudio SAUCE.
An Esp Pediatr, 56 (2002), pp. 9-19
[17.]
National Committee for Clinical Laboratory Standards.
Performance Standars for Antimicorbial Susceptibiliry Testing; twelfth edition M100-S13 NCCLS.
Performance Standars for Antimicorbial Susceptibiliry Testing; twelfth edition M100-S13 NCCLS, (2003),
[18.]
J. Yuste, I. Jado, A. Fenoll, L. Aguilar, M.J. Giménez, J. Casal.
β-lactam modification of the bacteraemic profile and its relationship with mortality in a pneumococcal mouse sepsis model.
J Antimicrob Chemother, 49 (2002), pp. 331-335
[19.]
A. Fenoll, J. Casal, M.J. Giménez, I. Jado, L. Aguilar.
Short-term bactericidal activity of amoxicillin and cefotaxime against penicillin susceptible and resistant pneumococcal strains: An in vitro pharmacodynamic simulations.
J Chemother, 12 (2000), pp. 124-128
[20.]
I.P. Balcabao, L. Aguilar, M. Martín, Y. García, R. Dal-Ré, J. Prieto.
Activities against Streptococcus pneumoniae of amoxicillin and cefotaxime at physiological concentrations: In vitro pharmacodynamic simulation.
Antimicrob Agents Chemother, 40 (1996), pp. 2904-2906
[21.]
L. Aguilar, J. Rosendo, I.P. Balcabao, M. Martín, M.J. Giménez, J. Frías, et al.
Pharmacodynamic effects of amoxicillin versus cefotaxime against penicillin-susceptible and penicillin-resistant penumococcal strains: A phase I study.
Antimicrob Agents Chemother, 41 (1997), pp. 1389-1391
[22.]
W.A. Craig.
Pharmacokinetic/Pharmacodynamic parameters: Rationale for antibacterial dosing of mice and men.
Clin Infec Dis, 26 (1998), pp. 1-12
[23.]
J. Oteo, J.I. Alós, J.L. Gómez-Garcés.
Antimicrobial resistance of Streptococcus pneumoniae isolates in 1999 and 2000 in Madrid, Spain: A multicentre surveillance study.
J Antimicrob Chemother, 47 (2001), pp. 215-218
[24.]
K.P. Klugman.
Antibiotic selection of multiply resistant pneumococci.
Clin Infect Dis, 33 (2001), pp. 489-491
[25.]
J. Prieto, J.E. Martín-Herrero, C. García-Rey.
Relación entre consumo de antibióticos y selección de resistencias en el género Streptococcus.
Med Preventiva, 8 (2002), pp. 23-30
[26.]
C. García-Rey, L. Aguilar, F. Baquero, J. Casal, R. Dal-Ré.
Importance of local variations in antibiotic consumption and geographical differences of erythromycin and penicillin resistance in Streptococcus pneumoniae.
J Clin Microbiol, 40 (2002), pp. 159-164
[27.]
M.C. Negri, M.I. Morosini, E. Loza, F. Baquero.
In vitro selective antibiotic concentrations of beta-lactams for penicillin-resistant Streptococcus pneumoniae populations.
Antimicrob Agents Chemother, 38 (1994), pp. 122-125
[28.]
F. Baquero.
Evolving resistance patterns of Streptococcus pneumoniae: A link with long-acting macrolide consumption?.
J Chemother, 11 (1999), pp. 35-43
[29.]
Bronzwaer Slam, O. Cars, U. Buchholz, S. Mölstad, W. Goettsch, I.K. Veldhuijzen, et al.
Degener and participants in the European Antimicrobial Resistance Surveillance System. A European Study on the relationship between antimicrobial use and antimicrobial resistance.
Emerg Infect Dis, 8 (2000), pp. 278-282
[30.]
F. Baquero, G. Baquero-Artigao, R. Cantón, C. García-Rey.
Antibiotic consumption and resistance selection in Streptococcus pneumoniae.
J Antimicrob Chemother, 50 (2002), pp. 27-37
[31.]
P. Dellamonica.
Preventing the risk of emergence of bacterial resistance associated with antibiotic therapy: What role for pharmacokinetic and pharmacodynamic data?.
J Antimicrob Chemother, 50 (2002), pp. 614-615
[32.]
M.H. Macris, N. Hartman, B. Murray, et al.
Studies of the continuining susceptibility of group A streptococcal strains to penicillin during eight decades.
Pediatr Infect Dis J, 17 (1998), pp. 377-381
[33.]
E. Pérez Trallero, M. Urbrena, M. Montes, et al.
Emergence of Streptococcus pyogenes strains resistant to erythromycin in Guipúzcoa, Spain.
Eur J Clin Microbiol Infect Dis, 17 (1998), pp. 25-31
[34.]
J.I. Alós, B. Aracil, J. Oteo, J.L. Gómez-Garcés.
Significant increase in the prevalence of erythromycin-resistant, clindamycin- and miocamycin-susceptible (M phenotype) Streptococcus pyogenes in Spain.
J Antimicrob Chemother, 51 (2003), pp. 333-337
[35.]
C. García-Rey, L. Aguilar, F. Baquero, J. Casal, J.E. Martín.
A pharmacoepidemiological analysis of the provincial differences between consumption of macrolides and rates of erythromycin resistance in Streptococcus pyogenes in Spain.
J Clin Microbiol, 40 (2002), pp. 2959-2963
[36.]
H. Seppalä, T. Klaukka, J. Vuopio-Varkila, et al.
The effect of changes in the consumption of macrolide antibiotics on erythromycin resistance in group A streptococci in Finland. Finnish Study Group for Antimicrobial Resistance.
N Engl J Med, 337 (1997), pp. 441-446
[37.]
M. Cizman, M. Pokorn, K. Seme, M. Paragi, A. Orazem.
Influence of increased macrolide consumption on macrolide resistance of common respiratory pathogens.
Eur J Clin Microb Infect Dis, 18 (1999), pp. 522-524
[38.]
D.E. Low.
Antimicrobial drug use and resistance among respiratory pathogens in the community.
Clin Infect Dis, 33 (2001), pp. S206-S213
[39.]
G. Cornaglia, M. Ligozzi, A. Mazzariol, L. Masala, G. Lo Cascio, G. Orefici, et al.
Resistance of Streptococcus pyogenes to erythromycin and related antibiotics in Italy. The Italian Surveillance Group for Antimicrobial Resistance.
Clin Infect Dis, 1 (1998), pp. S87-S92
[40.]
G.A. Syrogiannopoulos, I.N. Grivea, F. Fitoussi, C. Doit, G.D. Katopodis, E. Bingen, et al.
High prevalence of erythromycin resistance of Streptococcus pyogenes in Greek children.
Pediatr Infect Dis J, 20 (2001), pp. 863-868
[41.]
O. Cars, S. Molstad, A. Melander.
Variation in antibiotic use in the European Union.
Lancet, 357 (2001), pp. 1851-1853
[42.]
J. Oteo, J.I. Alós, J.L. Gómez-Garcés.
Sensibilidad in vitro actual de los patógenos respiratorios bacterianos más frecuentes: implicaciones clínicas.
Med Clin (Barc), 116 (2001), pp. 541-549
[43.]
W. Khan, S.E. Starr, W. Rodríguez, G. Controni, A.K. Sa.
Haemophilus influenzae type b resistant to ampicillin: A report of two cases.
Jama, 229 (1974), pp. 298-301
[44.]
B.A. Gunn, J.B. Woodall, J.F. Jones, C. Thornsberry.
Ampicillinresistant Haemophilus influenzae.
Lancet, 2 (1974), pp. 845
[45.]
F. Marco, J. García de Lomas, C. García-Rey, E. Bouza, L. Aguilar, C. Fernández-Mazarrasa.
and the Spanish Surveillance Group for Respiratory Pathogens. Antimicrobial susceptibilities of 1,730 Haemophilus influenzae respiratory tract isolates in Spain in 1998–1999.
Antimicrobial Agents Chemotherapy, 45 (2001), pp. 3226-3228
[46.]
B. Aracil, J.L. Gómez-Garcés.
Alós JI y Grupo de Estudio de Infección en Atención Primaria de la SEIMC (IAP-SEIMC). Sensibilidad de Haemophilus influenzae aislados en España a 17 antimicrobianos de administración oral.
Enferm Infecc Microbiol Clin, 21 (2003), pp. 131-136
[47.]
P.M. Mendelman, D.O. Chaffin, T.L. Stull, C.E. Rubens, K.D. Mack, A.L. Smith.
Characterization of non-β-lactamase-mediated ampicillin resistance in Haemophilus influenzae.
Antimicrob Agents Chemotherapy, 26 (1984), pp. 235-244
[48.]
National Committee for Clinical Laboratory Standards.
Performance Standars for Antimicorbial Susceptibiliry Testing; thirteenth edition M100-S13 NCCLS.
Nccls, (2003),
[49.]
P. Ball, F. Baquero, O. Cars, et al.
Antibiotic therapy of community respiratory tract infections: Strategies for optimal outcomes and minimized resistance emergence.
J Antimicrob Chemother, 49 (2002), pp. 31-40
[50.]
J. Garau.
Why do need to eradicate pathogens in respiratory tract infections?.
Int J Infect Dis, 7 (2003), pp. S5-S10
[51.]
S.A. Carlin, C.D. Marchant, P.A. Shurin, C.E. Johnson, D.M. Super, J.M. Rehmus.
Host factors and early therapeutic response in acute otitis media.
J Pediatr, 118 (1991), pp. 178-183
[52.]
R. Dagan, E. Leibovitz, D. Greenberg, et al.
Early eradication of pathogens from middle ear fluid during antibiotic treatment of acute otitis media is associated with improved clinical outcome.
Pediatr Infect Dis J, 17 (1998), pp. 776-782
[53.]
R. Dagan, E. Leibovitz.
Bacterial eradication in the treatment of otitis media.
Lancet Infect Dis, 2 (2002), pp. 593-604
[54.]
F.J. Catanzaro, C.A. Stetson, A.J. Morris, et al.
Symposium on rheumatic heart disease; the role of the streptococcus in the pathogenesis of rheumatic fever.
Am J Med, 17 (1954), pp. 749-756
[55.]
A.L. Bisno, M.A. Gerber, J.r. Gwaltney JM, E.L. Kaplan, R.H. Schwartz.
Diagnosis and management of group A streptoccal pharyngitis: A practice guideline.
Clin Infect Dis, 25 (1997), pp. 574-583
[56.]
M.A. Gerber, M. Markowitz.
Management of streptococcal pharyngitis reconsidered.
Pediatr Infect Dis J, 4 (1985), pp. 518-526
[57.]
B.B. Breese.
Treatment of beta hemolytic streptococcal infections in the home: Relative value of available methods.
Jama, 521 (1953), pp. 10-14
[58.]
J.D. Nelson.
The effect of penicillin therapy on the symptoms and signs of streptococcal pharyngitis.
Pediatr Infect Dis, 3 (1984), pp. 10-13
[59.]
M.S. Krober, J.W. Bass, G.N. Michels.
Streptococcal pharyngitis. Placebo controlled double-blind evaluation of clinical response to penicillin therapy.
Jama, 253 (1985), pp. 1271-1274
[60.]
R. Dagan, K.P. Klugman, W.A. Craig, F. Baquero.
Evidence to support the rationale that bacterial eradication in respiratory tract infection is an important aim of antimicrobial therapy.
J Antimicrob Chemother, 47 (2001), pp. 129-140
[61.]
R. Dagan, R. Melamed, M. Muallen, L. Piglansky, P. Yagupsky.
Nasopharyngeal colonization in southern Israel with antibitic- resistant pneumococci during the first 2 years of life: Relation to serotypes likely to be included in pneumococcal conjugate vaccines.
J Infect Dis, 174 (1996), pp. 1352-1355
[62.]
I. Brook, A.E. Gober.
Eradication of Streptococcus pneumoniae in the nasopharyngeal flora of children with acute otitis media after amoxicillin-clavulanate therapy.
Program and Abstracts of the 43rd Interscience Conference on Antimicrobial Agents and Chemotherapy, Chicago, USA [abstract G-1854],
[63.]
R. Dagan, A. Hoberman, C. Johnson, E.L. Leibovitz, A. Arguedas, F.V. Rose, et al.
Bacteriologic and clinical efficacy of high dose amoxicillin/clavulanate in children with acute otitis media.
Pediatr Infect Dis J, 20 (2001), pp. 829-837
[64.]
F. Ghaffar, L.S. Muniz, K. Katz, et al.
Effects of large dosages of amoxicillin/clavulanate or azithromycin on nasopharyngeal carriage of Streptococcus pneumoniae, Haemophilus influenzae, Non-pneumococcal α-Hemolytic streptococci, and Staphylococcus aureus in children with acute otitis media.
Clin Infect Dis, 34 (2002), pp. 1301-1309
[65.]
H. Dabernat, P. Geslin, F. Megraud, et al.
Effects of cefixime or co-amoxiclav treatment on nasopharyngeal carriage of Streptococcus pneumoniae and Haemophilus influenzae in children with acute otitis media.
J Antimicrob Chemother, 41 (1998), pp. 253-258
[66.]
R. Cohen, P. Reinert, F. De la Rocque, C. Levy, M. Boucherat, M. Robert, et al.
Comparison of two dosages of azithromycin for three days versus penicillin V for ten days in acute group A streptococcal tonsillopharyngitis.
Pediatr Infect Dis J, 21 (2002), pp. 297-303
[67.]
G.A. Syrogiannopoulos, I.N. Grivea, N.G. Beratis.
The Hellenic Antibiotic-Resistant Respiratory Pathogens Study Group. 5-Day high-dose clarithromycin (HD-CL, 30mg/kg/day bid) or Regular- Dose clarithromycin (RD-CL, 15mg/kg/day bid) or amoxicillin/ clavulanate (A/C) versus 10-day penicillin V (P) treatment for pediatric group A streptococcal tonsillopharyngitis.
Program and Abstracts of the 41st Interscience Conference on Antimicrobial Agents and Chemotherapy, Chicago, USA [abstract 1535], pp. 266
[68.]
W.R. Brink, C.H. Rammelkamp, F.W. Denny, L.W. Wannamaker.
Effect of penicillin and Aureomycin on the natural course of streptococcal tonsillitis and pharyngitis.
Am J Med, 10 (1951), pp. 300-308
[69.]
G.L. Drusano, W.A. Craig.
Relevance of pharmacokinetics and pharmacodynamics in the selection of antibiotics for respiratory tract infections.
J Antimicrob Chemother, 9 (1997), pp. 38-44
[70.]
W.A. Craig.
Pharmacokinetic/Pharmacodynamic parameters: Rationale for antibacterial dosing of mice and men.
Clin Infect Dis, 26 (1998), pp. 1-12
[71.]
M.K. Lacy, W. Lu, X. Xu, P.R. Tessier, D.P. Nicolau, R. Quintiliani, et al.
Pharmacodynamic comparisons of levofloxacin, ciprofloxacin, and ampicillin against Streptococcus pneumoniae in an in vitro model of infection.
Antimicrob Agents Chemother, 43 (1999), pp. 672-677
[72.]
M.R. Jacobs.
Optimisation of antimicrobial therapy using pharmacokinetic and pharmacodynamic parameters.
Clin Microbiol Infect, 7 (2001), pp. 589-596
[73.]
W.A. Craig.
Antimicrobial resistance issues of the future.
Diagn Microbiol Infect Dis, 25 (1996), pp. 213-217
[74.]
W.A. Craig, D. Andes.
Pharmacokinetics and pharmacodynamics of antibiotics in otitis media.
Pediatr Infect Dis J, 15 (1996), pp. 255-259
[75.]
D. Andes.
Pharmacokinetic and pharmacodynamic properties of antimicrobials in the therapy of respiratory tract infections.
Curr Opin Infect Dis, 14 (2001), pp. 165-172
[76.]
E. Alonso de Velasco, A.F. Verheul, J. Verhoef, H. Snippe.
Streptococcus pneumoniae: Virulence factors, pathogenesis, and vaccines.
Microbiol Rev, 59 (1995), pp. 591-603
Copyright © 2004. Asociación Española de Pediatría
