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Fluoroquinolone-Resistant S. Pneumoniae Emerging

Resistant pneumococcal disease seen in African children previously treated for tuberculosis

MONDAY, March 24 (HealthDay News) -- In South African children with multidrug-resistant tuberculosis, treatment with fluoroquinolones may have led to the emergence of invasive pneumococcal disease caused by fluoroquinolone-resistant Streptococcus pneumoniae, according the results of a study published online March 24 in The Lancet.

Between 2000 and 2006, Anne von Gottberg, of the National Institute for Communicable Diseases of the National Health Laboratory Service in Johannesburg, South Africa, and colleagues identified 21,521 patients with invasive pneumococcal disease, and screened isolates from 19,404 of them for ofloxacin resistance. They defined resistance to levofloxacin as a minimum inhibitory concentration of 4 mg/L or more.

The researchers found that 22 isolates were resistant to ofloxacin, 12 of which contained S. pneumoniae resistant to levofloxacin. All 12 cases of invasive pneumococcal disease resistant to levofloxacin occurred in children under age 15. The investigators also found that invasive disease caused by levofloxacin-resistant S. pneumoniae was associated with a previous history of tuberculosis treatment.

"Thirty years ago, the first multidrug-resistant pneumococci emerged in a limited, nosocomial setting in South Africa very similar to that described here," the authors write. "Now, multidrug-resistant pneumococci have spread worldwide. Interventions and changes in health policy are required to prevent the uncontrolled spread of levofloxacin resistance among pneumococci."

Two of the study authors have received research funds from Wyeth.

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