Novel cost-effective approaches to the treatment of community-acquired infections.
To review approaches to the diagnosis and treatment of patients with community-acquired infections. Dramatic changes in the antibiotic susceptibility of pathogens commonly associated with community-acquired infections have occurred during the past decade. Changes in the antibiotic sensitivity profile of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis that have occurred over the past several years have required modifications in empiric antibiotic selections for infections due to these pathogens. The most profound changes have occurred with S. pneumoniae, which has shown significant resistance to beta-lactams by means of alteration of one or more of the five important penicillin-binding proteins. Many of these organisms have become resistant to other classes of antibiotics; some are sensitive only to vancomycin. H. influenzae and M. catarrhalis have developed resistance primarily by production of beta-lactamase. The antibiotic selection process for the treatment of community-acquired pneumonia relates to the site of infection and, in many cases, the in vitro sensitivity testing results or known patterns in a given geographic area.