Rationale for Revised Penicillin Susceptibility Breakpoints versus Streptococcus pneumoniae: Coping with Antimicrobial Susceptibility in an Era of Resistance

In January 2008, the Clinical and Laboratory Standards Institute published revised susceptibility breakpoints for penicillin and Streptococcus pneumoniae, and shortly thereafter, the United States Food and Drug Administration similarly revised its breakpoints via changes in the package insert for pe...

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Bibliographic Details
Published in:Clinical infectious diseases 2009-06, Vol.48 (11), p.1596-1600
Main Authors: Weinstein, Melvin P., Klugman, Keith P., Jones, Ronald N.
Format: Article
Language:English
Subjects:
Anti-Bacterial Agents - pharmacology
Antibacterial agents
Antibiotics. Antiinfectious agents. Antiparasitic agents
Antimicrobial Resistance
Antimicrobials
Bacterial diseases
Biological and medical sciences
Dosage
Drug Resistance, Bacterial
Human bacterial diseases
Humans
Infectious diseases
Labor standards
Medical sciences
Microbial sensitivity tests
Microbial Sensitivity Tests - standards
Microbiology
Penicillin
Penicillins - pharmacology
Pharmacokinetics
Pharmacology. Drug treatments
Pneumococcal meningitis
Pneumococcal pneumonia
Pneumonia
Staphylococcal infections, streptococcal infections, pneumococcal infections
Streptococcus infections
Streptococcus pneumoniae
Streptococcus pneumoniae - drug effects
United States
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Summary:In January 2008, the Clinical and Laboratory Standards Institute published revised susceptibility breakpoints for penicillin and Streptococcus pneumoniae, and shortly thereafter, the United States Food and Drug Administration similarly revised its breakpoints via changes in the package insert for penicillin. The revised susceptibility breakpoint is ⩽2 µg/mL for nonmeningeal infections treated with parenteral penicillin at a dosage of 12 million units-24 million units per day. The susceptibility breakpoint of ⩽0.06 µg/mL remains unchanged for pneumococcal meningitis treated with parenteral penicillin at a dosage of ⩾18 million units per day. Herein, we review the scientific basis for the revisions to the breakpoints, which were supported by microbiologic, pharmacokinetic and/or pharmacodynamic, and clinical data. Clinicians, once again, should feel comfortable prescribing penicillin for pneumococcal pneumonia and other pneumococcal infections outside the central nervous system.
ISSN:1058-4838
1537-6591
DOI:10.1086/598975