From the beginning of the antibiotic era to the mid-1970s, Streptococcus pneumoniae (pneumococci) remained uniformly susceptible to all classes of antibiotics that had been active against the organisms, with the possible exception of tetracycline. Thus, the medical profession had a rude awakening in 1977 and 1978 when outbreaks of infection due to antibiotic-resistant pneumococci occurred in Durban and Johannesburg, South Africa [1,2]. These outbreaks originated in infectious diseases hospitals where children with serious viral infections were routinely treated "prophylactically" with antibiotics. Although they were originally called penicillin-resistant pneumococci (PRP), these organisms appeared to have acquired genetic material that encoded resistance both to penicillin and to other commonly used antibiotics.
In the ensuing decades, resistance of pneumococci to a variety of antimicrobial agents has evolved from an ominous medical curiosity to a worldwide health problem. Pneumococcal resistance has increased to a point that it is clinically relevant in the following classes of antibiotics:
●Beta-lactams (penicillins, cephalosporins, and carbapenems)
●Macrolides (erythromycin, azithromycin, clarithromycin and lincosamides [clindamycin])
●Tetracyclines and folate inhibitors (trimethoprim-sulfamethoxazole [TMP-SMX])