Robert G. Masterton

Streptococcus pneumoniae is the most frequent bacterial cause of community-acquired pneumonia,¹ acute sinusitis² and meningitis³ and is involved in a significant proportion of cases of acute exacerbation of chronic bronchitis.⁴ In addition, there is evidence that the incidence of invasive pneumococcal disease has increased.⁵ There is now concern over the increasing resistance of S. pneumoniae to penicillin and macrolides and the appearance of strains with reduced susceptibility to third-generation cephalosporins.⁶ As a result, there is a need for new agents with good activity against S. pneumoniae, especially those which can be administered orally.

The increase in antimicrobial resistance has led to predictions of doom in the international press and to depression in the medical community. It has focused attention upon measures for fighting resistance, foremost of which is susceptibility surveillance. Until recently, global efforts at surveillance have been largely uncoordinated and random. This scene is rapidly changing with the World Health Organization (WHO), among others, leading multidisciplinary, targeted initiatives. In terms of individual surveillance programmes, much has been learned about their design. The best of these, the Meropenem Yearly Susceptibility Test Information Collection (MYSTIC), SENTRY and the Alexander Project, involve well-defined patient and organism groups against key denominators, and use standardized, internationally recognized methods that are quality-controlled, explore susceptibility quantitatively and include investigation of resistance mechanisms. Results are rapidly returned to the user. Evidence shows that surveillance, when used to guide policies on antibiotic use and infection control, can be helpful in the fight to control the development and spread of resistance. Further work is required to demonstrate these benefits and quantify them fully.