1
40
1
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
URL Address
<a href="http://doi.org/10.2165/00003495-200363020-00005" target="_blank" rel="noreferrer noopener">http://doi.org/10.2165/00003495-200363020-00005</a>
Pages
181–205
Issue
2
Volume
63
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
International guidelines for the treatment of community-acquired pneumonia in adults: the role of macrolides.
Publisher
An entity responsible for making the resource available
Drugs
Date
A point or period of time associated with an event in the lifecycle of the resource
2003
1905-06
Subject
The topic of the resource
Adult; Humans; Microbial Sensitivity Tests; Anti-Infective Agents/*therapeutic use; Outpatients; Practice Guidelines as Topic; Clinical Trials as Topic; Community-Acquired Infections/drug therapy/microbiology; Treatment Failure; Inpatients; Macrolides/pharmacology/*therapeutic use; Drug Resistance; Pneumonia; Bacterial; Bacterial/*drug therapy/microbiology; Adjuvants; Immunologic/pharmacology/therapeutic use
Creator
An entity primarily responsible for making the resource
File Thomas M Jr; Tan James S
Description
An account of the resource
The significance of community-acquired pneumonia (CAP) has led to the publication of guidelines from numerous international organisations. Because the macrolide class of antimicrobials is active against most of the key pathogens associated with CAP, agents from this class are commonly included in recommendations from these guidelines. However, there are differences among the various guidelines concerning the positioning of the macrolides for empirical therapy. An important factor concerning the use of macrolides for CAP is the emergence of resistance of Streptococcus pneumoniae over the past decade. The rate of S. pneumoniae resistance to macrolides ranges from 4 to 70% of strains in worldwide surveillance studies. The most common mechanisms of resistance include methylation of a ribosomal target encoded by the erm gene and efflux of the macrolides by a cell membrane protein transporter, encoded by the mef gene. S. pneumoniae strains with the mef gene are resistant at a lower level (with minimum inhibitory concentration [MIC] values generally 1-16 microg/ml) than erm resistant strains; and it is possible that such strains may be inhibited if sufficiently high levels of macrolide can be obtained at the infected site. Currently mef-associated resistance predominates in North America, whereas erm predominates in Europe. Until recently, reports of failure of treatment of CAP with macrolides has been rare, particularly for patients with low-risk for drug-resistant strains. However, since 2000, several patients treated with an oral macrolide who have subsequently required admission to the hospital for macrolide-resistant S. pneumoniae (MRSP) bacteraemia have been reported in the literature. Major issues, which are fundamental to the use of the macrolides as recommended in the various guidelines, include the importance of providing therapy for 'atypical' pathogens and the clinical significance of MRSP. Presently, the macrolides are more prominently recommended in the North American guidelines than in other parts of the world. The difference in the emphasis placed on the importance of the atypical pathogens as well as the expression of MRSP in North America compared with Europe partly explains this variance.
Identifier
An unambiguous reference to the resource within a given context
<a href="http://doi.org/10.2165/00003495-200363020-00005" target="_blank" rel="noreferrer noopener">10.2165/00003495-200363020-00005</a>
Rights
Information about rights held in and over the resource
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
2003
Adjuvants
Adult
Anti-Infective Agents/*therapeutic use
Bacterial
Bacterial/*drug therapy/microbiology
Clinical Trials as Topic
Community-Acquired Infections/drug therapy/microbiology
Department of Internal Medicine
Drug Resistance
Drugs
File Thomas M Jr
Humans
Immunologic/pharmacology/therapeutic use
Inpatients
Macrolides/pharmacology/*therapeutic use
Microbial Sensitivity Tests
NEOMED College of Medicine
Outpatients
Pneumonia
Practice Guidelines as Topic
Tan James S
Treatment Failure