A review of clinical failures associated with macrolide-resistant Streptococcus pneumoniae

Marek Rzeszutek, Aleksandra Wierzbowski, Daryl J. Hoban, John Conly, William Bishai, George G. Zhanel

Research output: Contribution to journalReview articlepeer-review


The emerging reports of clinical failures using macrolides and their associations with macrolide-resistant Streptococcus pneumoniae prompted us to review the literature describing these cases. Thirty-three cases reporting macrolide treatment failure during treatment of pneumococcal infections were available for review. The most prevalent diagnosis (24/27 or 88.8% of available diagnoses) was community-acquired pneumonia (CAP). Previous medical history included cardiopulmonary disease in eight (24.2%) and immunocompromised states in five (15.1%) patients. The majority, 31/33 (93.9%) of patients received oral macrolide treatment in an outpatient setting. S. pneumoniae was isolated from the blood in 26 (78.8%) of 33 patients, three (9.1%) patients had bacteria present in both blood and cerebrospinal fluid, two (6%) patients grew S. pneumoniae from blood and bronchial washings and two (6%) patients had positive sputum cultures. The MLSB phenotype was the most predominant phenotype present in 12 (63.2%) of 19 patients. After failing initial macrolide treatment, 26 (78.8%) of 33 patients received parenteral antibiotic treatment. Of 33 patients admitted to hospital, 29 (87.8%) had their outcome described as 'survived'.

Original languageEnglish (US)
Pages (from-to)95-104
Number of pages10
JournalInternational Journal of Antimicrobial Agents
Issue number2
StatePublished - Aug 2004


  • Macrolide resistance
  • S. pneumoniae
  • Treatment failure

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases
  • Pharmacology (medical)


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