Emergence of antimicrobial resistance in community-acquired pulmonary pathogens.

Antibiotic resistance to the common respiratory tract pathogens is increasing worldwide. Penicillin-resistant pneumococci are of particular concern. Most strains of penicillin-resistant Streptococcus pneumoniae have intermediate resistance to penicillin, and highly resistant strains are rare at present. Careful selection of antibiotics with low resistance potential and excellent activity against highly penicillin-resistant pneumococci (ie, cefotaxime, ceftriaxone, cefepime, cefprozil, doxycycline, levofloxacin, sparfloxacin, and meropenem) is the best current strategy to delay or increase the emergence of highly penicillin-resistant strains of S pneumoniae.