Updated Recommendations for Prescribing First Line Oral Antibiotics for Respiratory Infections with Streptococcus pneumoniae
A new study encourages a change in recommendations when prescribing first line oral antibiotics for respiratory infections with Streptococcus pneumoniae in Wisconsin. Based on local antimicrobial resistance trends, doxycycline is more likely to be effective than azithromycin when using monotherapy.
In 2019, the American Thoracic Society and Infectious Diseases Society of America updated clinical practice guidelines for community-acquired pneumonia (CAP). In contrast to guidelines published in 2007, macrolide monotherapy for outpatients was only recommended if the percentage of resistant isolates was less than 25%. Wisconsin antimicrobial susceptibility data was needed to guide management of CAP and other bacterial respiratory infections, including sinusitis and otitis media, to utilize this conditional recommendation most effectively.
The Wisconsin Department of Health Services (DHS), Wisconsin State Laboratory of Hygiene (WSLH), and collaborators from Marquette University evaluated data from Marquette’s Surveillance of Wisconsin Organisms for Trends in Antimicrobial Resistance and Epidemiology (SWOTARE) program. This evaluation investigated local antimicrobial susceptibility profiles and geographic trends for Wisconsin Streptococcus pneumoniae isolates between 2016 and 2020.
Key findings include:
- Susceptibility rates for Streptococcus pneumoniae isolates were less than 75% for macrolides (that is, azithromycin) across all regions of Wisconsin.
- The macrolide susceptibility rate from 2016–2020 was a significant reduction from that observed previously in 2006–2010.
- High-level macrolide resistance was noted in 24.8% of Streptococcus pneumoniae isolates.
- Rates of Streptococcus pneumoniae susceptibility to penicillin, cephalosporins, doxycycline, and fluoroquinolones remained high throughout Wisconsin.
Implications for clinical treatment:
- Azithromycin monotherapy for CAP should be avoided.
- High-dose oral amoxicillin is likely to still be effective for CAP.
- If using a single agent to treat CAP, prescribers can consider doxycycline based on low levels of resistance.
Additional details are contained within the full article text. DHS encourages clinicians to review these latest data trends for effective evidence-based prescribing practices.
Questions?
For questions, please reach out the the Healthcare-Associated Infections (HAI) Prevention Program at DHSWIHAIPreventionProgram@dhs.wisconsin.gov
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