Epidemiology of pneumococcal infections in French children

Since 1977, resistance to beta -lactams and other families of antibiotics among isolates of Streptococcus pneumoniae has increased alarmingly worldwide. France is particularly affected by this phenomenon; in 1997 the French National Reference Centre for Pneumococci reported that 44% of S. pneumoniae strains were penicillin non-susceptible (PNSS). Furthermore, resistance to macrolides (53%) and sulphonamides (37%) was comparable; in addition, >50% of PNSS had a high level of resistance to penicillin and were multiresistant. The highest frequency of resistance is observed in children, particularly those with acute otitis media (AOM). Conclusion: The clinical consequences of increasing antibiotic resistance are evident for meningitis and AOM, prompting clinicians to consider alternative agents such as high-dose cefotaxime (300 mg/kg/d) or ceftriaxone (100 mg/kg/d) plus vancomycin (60 mg/kg/d) for meningitis, and high;dose amoxicillin (>80 mg/kg/d) or ceftriaxone (50 mg/kg/d) for AOM.