[Current in vitro sensitivity of the most frequent bacterial respiratory pathogens: clinical implications]

¿Cuál es la importancia de la erradicación bacteriana en el tratamiento de la infección respiratoria?

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 pneumoniae to 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 in S. 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.

[Pneumococcal pneumonia in hospitalized patients. Therapeutic implications of resistances to penicillin and erythromycin]

BACKGROUND AND OBJECTIVE

Streptococcus pneumoniae is the main etiological agent of community-acquired pneumonia. The aim of this work was to ascertain the resistance profiles of pneumococcus to penicillin and erythromycin and to analyse whether such profiles lead to different disease developments.

PATIENTS AND METHOD

A retrospective analysis was carried out in 75 cases of pneumococcal pneumonia corresponding to hospitalized patients. Comorbidity factors were evaluated including their influence on the appearance of resistance.

RESULTS

67 patients (89.3%) presented comorbidity factors. 49.3% isolates displayed some type of resistance: 38.6% to penicillin, 36% to erythromycin and 13.3% to cefotaxime. No relationship was observed between the severity of the pneumonia and antibiotic resistance. Complications and mortality were not influenced by the susceptibility of pneumococcus to antibiotics.

CONCLUSION

The increase in the resistance to antibiotics, especially erythromycin, makes betalactams the best choice for the treatment of pneumococcal pneumonia.

[Survey of the judicious use of antibiotics in primary care]

OBJECTIVE

To identify pediatricians' antibiotic prescribing habits in acute otitis media and tonsillopharyngitis and to determine the interaction between parents and pediatricians concerning antibiotic use in the Autonomous Community of Valencia (Spain).

METHOD

Four hundred members of the Valencian Society of Pediatrics were randomly selected. A semi-structured questionnaire with non-excluding answers was sent by mail and, when responses were not obtained, a second one was sent. The confidentiality of the information was guaranteed.

RESULTS

Of 400 questionnaires sent, 143 (35.8 %) were completed; 88.1 % were completed by pediatricians and 51.1 % by primary care workers. A total of 48.3 % of pediatricians used antibiotics in all cases of acute otitis media and 94.5 % prescribed them when fever and otalgia persisted for more than 48 hours. Amoxicillin-clavulanate was the most frequently prescribed antibiotic (63.6 %). Less than 10 % of pediatricians prescribed antibiotics as empirical treatment in tonsillopharyngitis; amoxicillin was the most frequently prescribed antibiotic (54.6 %). Indications for antibiotic treatment were fever, odynophagia and adenomegaly (69.5 %) and tonsillar exudate (62.5 %). Inappropriate antibiotic use was mainly due to excess workload. Providing health education to parents could be the best way of reducing inappropriate use.

CONCLUSIONS

Antibiotic use is frequent in the treatment of acute otitis media. Amoxicillin-clavulanate and amoxicillin were the most frequently prescribed antibiotics in tonsillopharyngitis. Providing health education to parents and reducing pediatricians' workload would decrease inappropriate antibiotic use.