1 Sept 2017

Bacterial resistance raises doubts about pneumonia antibiotic use

Professor Allen Cheng is an infectious diseases physician
at the Alfred

by Anne Crawford

Monash University scientists reviewing an antibiotic commonly used to treat pneumonia have concluded that it may no longer be reliable as a monotherapy for serious infections due to bacterial resistance.

Macrolide antibiotics, which include erythromycin, clarithromycin and azithromycin, are an important class of antimicrobials for pneumococcal diseases.

However, a report by Professor Allen Cheng from the Department of Infectious Diseases, and Senior Adjunct lecturer Dr Adam Jenney found that macrolide,  most commonly used in combination with effective antibiotics such as penicillin or cephalosporins, may not be reliable as monotherapy for serious pneumococcal disease.

The report was commissioned by the editors of the journal 'Pneumonia'.

It found that the highest rates of resistance have been reported in East Asia (particularly China, Japan, and South Korea) with rapid increases in resistance occurring in Malaysia.

Professor Cheng had observed increasing resistance to macrolide antibiotics in a previous study of Indigenous Australian and Alaska Native children with bronchiectasis, a chronic lung infection.

However, the antibiotics were used in this case for their effect in damping down the immune system rather than for their antibacterial properties so resistance was not as important as it might otherwise have been.

The report concluded that the data suggested that macrolides may not be able to be relied on as monotherapy for serious pneumococcal infections.

Such studies provide information on the benefits and disadvantages for administering various antibiotics – useful information for clinicians and others. Antimicrobial resistance, which threatens the effective prevention and treatment of a multitude of infections caused by bacteria, is an increasingly challenging threat to global health.

“We don’t like resistance in general but there are antibiotics that are really important – at least for pneumococcal infections, losing macrolides is not as much of a disaster than for some other antibiotics,” Professor Cheng said.

Concerns about resistance have been raised over the high use of macrolide antibiotics in animals, particularly in poultry production. However, the use of macrolides in that case are probably preferable to the use of other antibiotics of higher importance to human health, he said.

Cheng AC, Jenney AWJ. Macrolide resistance in pneumococci-is it relevant? Pneumonia (Nathan). 2016 Jul 7;8:10. doi: 10.1186/s41479-016-0010-1. eCollection 2016.

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