Korean Journal of Pediatrics 2008;51(10):1031-1037.
Published online October 15, 2008.
Emergence of macrolide resistance and clinical use of macrolide antimicrobials in children
Eun Hwa Choi
Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
Macrolide계 항균제 내성 출현과 소아에서의 임상적 적용
서울대학교 의과대학 소아과학교실
Eun Hwa Choi, Email: eunchoi@snu.ac.kr
Macrolide antimicrobial agents including erythromycin, roxithromycin, clarithromycin, and azithromycin are commonly used in the treatment of respiratory tract infections in children. Newer macrolides that have structural modifications of older drug erythromycin show improved change in the spectrum of activity, dosing, and administration. However, recent studies reported that increasing use of macrolide antibiotics is the main force driving the development of macrolide resistance in streptococci. In particular, azithromycin use is more likely to select for macrolide resistance with Streptococcus pneumoniae than is clarithromycin use, a possible reflection of its much longer half life. Recently, erythromycin resistance rates of S. pneumoniae and Streptococcus pyogenes are rapidly increasing in Korea. Two main mechanisms of acquired macrolide resistance have been described, altered binding site on the bacterial ribosome encoded by the ermB gene and active macrolide efflux pump encoded by the mef gene. Relationship between the susceptibility of S. pneumoniae and the response to macrolides has been shown in studies of acute otitis media, but less clear in cases of pneumonia. This article reviews the spectrum of activity, pharmacokinetic properties, mechanisms of action and resistance, and clinical implication of resistance on the treatment of respiratory tract infections in children.
Key Words: Macrolide, Resistance, Streptococcus pneumoniae, Streptococcus pyogenes

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