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Telithromycin is highly effective against macrolide-resistant Streptococcus pneumoniae including strains with high-level erythromycin A resistance



Telithromycin is highly effective against macrolide-resistant Streptococcus pneumoniae including strains with high-level erythromycin A resistance



Abstracts of the Interscience Conference on Antimicrobial Agents & Chemotherapy 42: 170



Background: The worldwide prevalence of erythromycin A (ERY)-resistant (R) Streptococcus pneumoniae (ERSP) is increasing. The MICs of ERY-R strains are frequently above levels achievable by macrolides in serum and tissue. The efficacy of telithromycin (TEL), the first ketolide antibacterial, which has been designed specifically to offer optimal spectrum coverage in respiratory tract infections, including those caused by resistant strains, was assessed in patients with community-acquired pneumonia (CAP) or acute maxillary sinusitis (AMS), in whom ERSP was isolated. Methods: A total of 314 clinical isolates of S. pneumoniae were obtained from adult patients with CAP (n=210) and AMS (n=104) who took part in one of 9 multicenter clinical trials and received either 5- or 7-10-day TEL 800 mg once daily. Isolates were tested for susceptibility to ERY at a central lab using NCCLS broth microdilution procedures. Resistance to ERY was defined as a MIC gtoreq1.0 mg/L. Genotyping was performed using the polymerase chain reaction method. Clinical and bacteriologic outcomes were assessed at a post-therapy visit (Days 17-24). Results: 37/265 (14%) ERSP were isolated in the bacteriologic per-protocol population. Patients with ERSP showed high rates of clinical cure and bacteriologic eradication (both 83.8% (31/37)). Corresponding clinical cure and bacteriologic eradication rates for all pneumococci isolates were both 93.6% (248/265). Among 24 patients from whom ERSP was isolated at baseline with ERY MICs gtoreq16 mg/L, 21 (87.5%) achieved clinical cure with bacteriological eradication, including 9/9 (100%) with an ERY MIC gtoreq512 mg/L. Of the 9 ERSP with an ERY MIC gtoreq512 mg/L, 7 were erm(B) and 2 were erm(B)/mef(E) genotypes. Conclusion: TEL is highly effective against clinical isolates of ERSP, including those with elevated MICs to ERY.

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Accession: 035832067

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