Antibacterial resistance among children with community-acquired respiratory tract infections (PROTEKT 1999-2000)

Objective. To determine the susceptibility of bacterial respiratory tract pathogens, isolated from children (0-12 years) as part of the global PROTEKT surveillance study (1999-2000), to a range of antibacterials, including the ketolide telithromycin. Methods. Minimum inhibitory concentrations of the antibacterials studied were determined at a central laboratory using the NCCLS microdilution broth method. Macrolide resistance mechanisms were detected by PCR. Results. Of 779 Streptococcus pneumoniae isolates worldwide, 43% were nonsusceptible to penicillin (18% intermediate; 25% resistant) and 37% were resistant to erythromycin, with considerable intercountry variation. Eighteen per cent of 653 Haemophilus influenzae and >90% of 316 Moraxella catarrhalis isolates produced beta-lactamase. Of 640 Streptococcus pyogenes isolates, 10% were resistant to erythromycin, with considerable intercountry variation. All S. pneumoniae and 99.8% of H. influenzae isolates were susceptible to telithromycin using breakpoints proposed to the NCCLS (less than or equal to1 and less than or equal to4 mg/L, respectively). All M. catarrhalis and 97% of S. pyogenes and isolates were susceptible to less than or equal to1 mg/L telithromycin. Conclusions. Antibacterial resistance complicates the empirical treatment of respiratory tract infections in children and requires continued monitoring. Telithromycin may be a useful therapeutic alternative as it is highly active against strains exhibiting various resistance phenotypes. (C) 2003 The British Infection Society. Published by Elsevier Ltd. All rights reserved.