Guideline for Antibiotic Use in Adults with Community-acquired Pneumonia

Lee, Mi Suk; Oh, Jee Youn; Kang, Cheol-In; Kim, Eu Suk; Park, Sunghoon; Rhee, Chin Kook; Jung, Ji Ye; Jo, Kyung-Wook; Heo, Eun Young; Park, Dong-Ah; Suh, Gee Young; Kiem, Sungmin

S. pneumoniae isolated in Korea have been reported to be highly resistant against penicillin. In an investigation on antibacterial resistance measured according to the antimicrobial susceptibility testing standards, S. pneumoniae were moderately or highly resistant to penicillin [17] . However, as experts claimed that there is no association between clinical outcomes of pneumonia caused by penicillin-resistant S. pneumoniae and antibiotic resistance against penicillin, the anti- Table 4 summarizes the current antibiotic resistance of S. pneumoniae strains isolated in Korea. While then antibiotic resistance against penicillin and ceftriaxone is reported to be low at 10% or below, that against erythromycin and azithromycin are still high at 73-81% [18] [19] [20] [21] [22] . Antibiotic resistance against fluoroquinolones is still quite low, but gradually increasing. Antibiotic resistance against levofloxacin and moxifloxacin is reported at 0.8-8.2%, and 0.9-1.0%, respectively [18, 20] . Resistance against ampicillin due β-lactamase production is common in H. influenzae. In a domestic study that analysed 544 bacterial strains, the antibiotic resistance against ampicillin, cefuroxime, clarithromycin, cefaclor, and amoxicillin/ clavulanate was 58.5%, 23.3%, 18.7%, 17.0%, and 10.4%, respectively [23] . This study did not identify bacterial strains that are resistant to levofloxacin and cefotaxime. In another study that analysed 229 bacterial strains, the antibiotic resistance against ampicillin high at 58.1%, and that against cefaclor, [24] . Not many studies have analysed the antibiotic susceptibility of M. pneumoniae in Korea. In a study that examined M. pneumoniae isolated from respiratory organ samples of pediatric patients in 2000-2011, genes related to macrolide resistance was detected in 31.4% of the samples, and this rate was reported to increase every year [25] . In another study using respiratory organ samples from pediatric patients, genes related to macrolide resistance were found in 17.6% of the samples of M. pneumoniae [26] . Although the ratio of methicillin-resistant S. aureus (MRSA) in community-acquired S. aureus infection has been increasing in Korea, systematic research on the role of MRSA in community-acquired pneumonia is lacking [27] [28] [29] .