PENICILLIN RESISTANT PNEUMOCOCCI IN FRANCE AND BETA-LACTAM AGENTS - UPDATE OF THE CENTER-NATIONAL-DE-REFERENCE

Since 1987, penicillin-resistant pneumococci are isolated with increasing frequency in France without reaching anyway the percentage reported in South Africa, Spain, Hungary. Those strains are often multiply resistant pneumococci. Thus detection of these strains appears to be now necessary. Penicillin and all beta-lactam antibiotics show higher MICs against these strains, however among beta-lactam antibiotics different degrees of resistance can be observed. Imipenem, amoxicillin and injectable thrid generation cephalosporins remain the most active. These molecules have bactericidal activity at 2xMIC or 4xMIC. MICs of first, second and third oral cephalosporins against these strains are over their blood levels. Blood level with cefuroxime axetil and cefpodoxime proxetil just reach the MICs of resistant strains. According to the bacteriological and pharmacocinetic data, most active beta-lactam antibiotics are imipenem, amoxicillin, cefotaxime and ceftriaxone and then penicillin and ampicillin. Against resistant strains (MICs greater-than-or-equal-to 4 mg/l) vancomycin seems to be the best choice.