Abstract
Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis resistance to traditional first-line antibiotic choices has risen dramatically over the past 5 years. This trend necessitates a reevaluation of the standard treatment paradigms, as inappropriate antibiotic use appears to be at least partially responsible for the selection of resistant strains. A practical approach may be to estimate the risk that a patient may harbor a resistant organism as a guide to antibiotic choices. For those at lower risk, continuing to prescribe traditional therapy such as amoxicillin or trimethoprim—sulfamethoxazole may be appropriate. For those at higher risk, a broader spectrum agent may be preferred. Empiric antibiotic therapy may need to give way to pathogen-directed choices in the near future as the complexity and prevalence of resistant strains continue to rise. Improved microbiologic diagnostic tools will be needed to face this challenge.
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