Complicated pneumococcal pneumonia: do not think to penicillin-resistance

Gianluca Tornese, Resident in Paediatrics,
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Other Contributors:

May 13, 2011

Dear Editor,

the "Best Practice" article by Randle et al. (1) on invasive pneumococcal disease gives a complete and up-to-date review on this topic. Notwithstanding the Authors did not mention the fact that at least complicated pneumonia (necrotizing pneumonia, pleural effusion, pleural empyema, lung abscess) are not related to penicillin-resistance of Streptococcus pneumoniae (2-4). Since an increasing number of cases complicated pneumonia among invasive pneumococcal disease has been described (2), it should be clearly stated that this effect is not related to penicillin-resistance, but rather to the so called "serotype replacement" after the introduction of 7-valent vaccine (1,5), which cannot be excluded with the 13-valent vaccine too (1). In our opinion, this data is not irrelevant and secondary in everyday clinical practice, and should be pointed out in order to provide the best medical practice and to avoid useless drug choice or changes, since treatment failure is usually due to instrinsic pathogenicity of Streptococcus pneumoniae and children with either intermediate or highly resistant penicillin-resistant Streptococcus pneumoniae were not more likely to experience treatment failure (3).

Gianluca Tornese, Federico Marchetti Department of Peadiatrics Institute of Child Health IRCCS "Burlo Garofolo" University of Trieste Trieste, Italy


1. Randle E, Ninis N, Inwald D. Invasive pneumococcal disease. Arch Dis Child Educ Pract Ed. 2011;0:adc.2010.191718v1-edpract191718

2. Tan TQ, Mason EO Jr, Wald ER, et al. Clinical characteristics of children with complicated pneumonia caused by Streptococcus pneumoniae. Pediatrics. 2002;110(1 Pt 1):1-6.

3. Cardoso MR, Nascimento-Carvalho CM, Ferrero F, et al. Penicillin- resistant pneumococcus and risk of treatment failure in pneumonia. Arch Dis Child. 2008;93(3):221-5.

4. Clifford V, Tebruegge M, Vandeleur M, Curtis N. Question 3: can pneumonia caused by penicillin-resistant Streptococcus pneumoniae be treated with penicillin? Arch Dis Child. 2010;95(1):73-7.

5. Singleton RJ, Hennessy TW, Bulkow LR, et al. Invasive pneumococcal disease caused by nonvaccine serotypes among alaska native children with high levels of 7-valent pneumococcal conjugate vaccine coverage. JAMA. 2007;297(16):1784-92.

Conflict of Interest:

None declared

Conflict of Interest

None declared