The continued spread of
penicillin-resistant pneumococci raises therapeutic concerns. Optimal
therapy for resistant
infections is unknown and it is not clear whether the efficacy of
penicillin or equally active
beta-lactam agents is compromised in non-meningeal-resistant
infections. A prospective nonintervention study was undertaken to compare the clinical response in
penicillin-resistant vs.
penicillin-susceptible bacteremic
pneumococcal infections, excluding
meningitis. Of 108 children enrolled, 35 (32%) had
penicillin-resistant (one highly resistant) isolates. Seventy-eight children had
pneumonia, 21 had occult
bacteremia (
sepsis) and 9 had
peritonitis. Children with resistant
infections were more likely to have underlying disorders, especially human immunodeficiency virus
infection, and to have received antimicrobial
therapy in the previous month. After 48 hours of
therapy 64% of
penicillin-susceptible
infections showed improvement vs. 60% of
penicillin-resistant
infections (odds ratio, 1.2; 95% confidence intervals, 0.5 to 3.0). In children with
pneumonia treated with
ampicillin or an equivalent
beta-lactam agent, 93% with
penicillin-susceptible
infections had improved by Day 7 of
therapy compared with 88% with resistant
infections (odds ratio, 1.9; 95% confidence interval 0.3 to 15.9). The durations of respiratory distress,
fever and
oxygen requirement were similar in
penicillin-susceptible and -resistant
infections. These results suggest that intermediate penicillin resistance is of little significance in
pneumococcal pneumonia or
sepsis and that standard
beta-lactam therapy is still highly effective. Further studies of highly
penicillin-resistant
infections are necessary.