Antimicrobial Resistance among Pediatric Respiratory Tract Infections: Clinical Challenges

Seminars in Pediatric Infectious Diseases

Volumn 15, Issue 1, 2004, Pages 5-20

  Jacobs, Michael R ^a   Dagan, Ron ^b  

^a CASE WESTERN RESERVE UNIVERSITY SCHOOL OF MEDICINE   (United States)

^b NONE

Author keywords

[No Author keywords available]

Indexed keywords

AMOXICILLIN; AMOXICILLIN PLUS CLAVULANIC ACID; AMPICILLIN; ANTIBIOTIC AGENT; AZITHROMYCIN; CEFACLOR; CEFDINIR; CEFEPIME; CEFETAMET; CEFIXIME; CEFOTAXIME; CEFPODOXIME; CEFPROZIL; CEFTAZIDIME; CEFTRIAXONE; CEFUROXIME; CEFUROXIME AXETIL; CLARITHROMYCIN; CLINDAMYCIN; ERTAPENEM; ERYTHROMYCIN; IMIPENEM; MEROPENEM; PENICILLIN G; PIPERACILLIN; PNEUMOCOCCUS VACCINE; QUINOLINE DERIVED ANTIINFECTIVE AGENT; TELITHROMYCIN; TICARCILLIN; UNINDEXED DRUG;

ANTIBIOTIC RESISTANCE; CHILD; CHLAMYDOPHILA PNEUMONIAE; COMMUNITY ACQUIRED PNEUMONIA; HAEMOPHILUS INFLUENZAE; HUMAN; HUMAN IMMUNODEFICIENCY VIRUS INFECTION; INFLUENZA; KLEBSIELLA PNEUMONIAE; LEGIONELLA PNEUMOPHILA; MEASLES; MINIMUM INHIBITORY CONCENTRATION; MORAXELLA CATARRHALIS; MYCOBACTERIUM TUBERCULOSIS; MYCOPLASMA PNEUMONIAE; OTITIS MEDIA; PRACTICE GUIDELINE; PREVALENCE; RESPIRATORY SYNCYTIAL PNEUMOVIRUS; RESPIRATORY TRACT INFECTION; REVIEW; SINUSITIS; STAPHYLOCOCCUS AUREUS; STREPTOCOCCUS PNEUMONIAE; STREPTOCOCCUS PYOGENES; VACCINATION; VIRUS INFECTION;

EID: 2442606598     PISSN: 10451870     EISSN: None     Source Type: Journal    
DOI: 10.1053/j.spid.2004.01.003     Document Type: Review

References (117)

1. Cappelletty D: Microbiology of bacterial respiratory infections. Pediatr Infect Dis J 17:S55-S61, 1998
2. Vives M, Garcia ME, Saenz P, et al: Nasopharyngeal colonization in Costa Rican children during the first year of life. Pediatr Infect Dis J 16:852-858, 1997
3. Ekdahl K, Ahlinder I, Hansson HB, et al: Duration of nasopharyngeal carriage of penicillin-resistant Streptococcus pneumoniae: Experiences from the South Swedish Pneumococcal Intervention Project. Clin Infect Dis 25:1113-1117, 1997
4. Giebink GS: Childhood sinusitis: pathophysiology, diagnosis and treatment. Pediatr Infect Dis J 13:S55-S58; discussion S63-S65, 1994
5. Dagan R, McCracken GH Jr: Flaws in design and conduct of clinical trials in acute otitis media. Pediatr Infect Dis J 21: 894-902, 2002
6. Bradley JS: Managament of community-acquired pediatric pneumonia in an era of increasing antibiotic resistance and conjugate vaccines. Pediatr Infect Dis J 21:592-598; discussion 613-614, 2002
7. Gehanno P, Lenoir G, Berche P: In vivo correlates for Streptococcus pneumoniae penicillin resistance in acute otitis media. Antimicrob Agents Chemother 39:271-272, 1995
8. Dowell SF, Butler JC, Giebink GS, et al: Acute otitis media-management and surveillance in an era of pneumococcal resistance-a report from the Drug-resistant Streptococcus pneumoniae Therapeutic Working Group. Pediatr Infect Dis J 18: 1-9, 1999
9. Finkelstein JA, Davis RL, Dowell SF, et al: Reducing antibiotic use in children: a randomized trial in 12 practices. Pediatrics 108:1-7, 2001
10. Sinus & Allergy Health Partnership: Antimicrobial treatment guidelines for acute bacterial rhinosinusitis. Sinus and Allergy Health Partnership. Otolaryngol Head Neck Surg 123:5-31, 2000
11. Bartlett J: Treatment of community-acquired pneumonia. Chemotherapy 46:24-31, 2000
12. Heiskanen-Kosma T, Korppi M, Jokinen C, et al: Etiology of childhood pneumonia: serologic results of a prospective, population-based study. Pediatr Infect Dis J 17:986-991, 1998
13. Schwartz RH, Freij BJ, Ziai M, Sheridan MJ: Antimicrobial prescribing for acute purulent rhinitis in children: a survey of pediatricians and family practitioners. Pediatr Infect Dis J 16:185-190, 1997
14. Gonzales R, Malone DC, Maselli JH, Sande MA: Excessive antibiotic use for acute respiratory infections in the United States. Clin Infect Dis 33:757-762, 2001
15. Jacobs MR, Dagan R, Appelbaum PC, Burch DJ: Prevalence of antimicrobial-resistant pathogens in middle ear fluid: multinational study of 917 children with acute otitis media. Antimicrob Agents Chemother 42:589-595, 1998
16. Vuori-Holopainen E, Salo E, Saxen H, et al: Etiological diagnosis of childhood pneumonia by use of transthoracic needle aspiration and modern microbiological methods. Clin Infect Dis 34:583-590, 2002
17. Dagan R, Leibovitz E: Bacterial eradication in the treatment of otitis media. Lancet Infect Dis 2:593-604, 2002
18. Howie VM, Ploussard JH: The "in vivo sensitivity test"-bacteriology of middle ear exudate, during antimicrobial therapy in otitis media. Pediatrics 44:940-944, 1969
19. Coles CL, Kanungo R, Rahmathullah L, et al: Pneumococcal nasopharyngeal colonization in young South Indian infants. Pediatr Infect Dis J 20:289-295, 2001
20. Gold HS, Moellering RC Jr: Antimicrobial-drug resistance. N Engl J Med 335:1445-1453, 1996
21. NCCLS Performance Standards for Antimicrobial Susceptibility Testing; Twelfth Informational Supplement (M100-S12). 2002.
22. Jacobs, MR, Felmingham, D, Appelbaum, PC, et al The Alexander Project 1998-2000: Susceptibility of pathogens isolated from community-acquired respiratory tract infection to commonly used antimicrobial agents. J Antimicrob Chemother 52:229-246, 2003.
23. Hakenbeck R, Kaminski K, Konig A, et al: Penicillin-binding proteins in beta-lactam-resistant streptococcus pneumoniae. Microb Drug Resist 5:91-99, 1999
24. Jacobs MR: In vivo veritas: in vitro macrolide resistance in systemic Streptococcus pneumoniae infections does result in clinical failure. Clin Infect Dis 35:565-569, 2002
25. Lonks JR, Garau J, Gomez L, et al: Failure of macrolide antibiotic treatment in patients with bacteremia due to erythromycin-resistant Streptococcus pneumoniae. Clin Infect Dis 35: 556-564, 2002
26. Dagan R, Johnson CE, McLinn S, et al: Bacteriologic and clinical efficacy of amoxicillin/clavulanate vs azithromycin in acute otitis media. Pediatr Infect Dis J 19:95-104, 2000
27. Dagan R, Leibovitz E, Fliss DM, et al: Bacteriologic efficacies of oral azithromycin and oral cefaclor in treatment of acute otitis media in infants and young children. Antimicrob Agents Chemother 44:43-50, 2000
28. Felmingham D, Gruneberg RN: The Alexander Project 1996-1997: Latest susceptibility data from this international study of bacterial pathogens from community-acquired lower respiratory tract infections. J Antimicrob Chemother 45:191-203, 2000
29. CDC: Surveillance for penicillin-nonsusceptible Streptococcus pneumoniae-New York City, 1995. MMWR 46:297-299, 1997
30. Whitney CG, Farley MM, Hadler J, et al: Increasing prevalence of multidrug-resistant Streptococcus pneumoniae in the United States. N Engl J Med 343:1917-1924, 2000
31. Jacobs MR, Bajaksouzian S, Zilles A, et al: Susceptibilities of Streptococcus pneumoniae and Haemophilus influenzae to 10 oral antimicrobial agents based on pharmacodynamic parameters: 1997 U.S. surveillance study. Antimicrob Agents Chemother 43:1901-1908, 1999
32. Scheifele D, Halperin S, Vaudry W: Historic low Haemophilus influenzae type B case tally-Canada 2000. Can Commun Dis Rep 27:149-150, 2001
33. Klein JO: Role of nontypeable Haemophilus influenzae in pediatric respiratory tract infections. Pediatr Infect Dis J 16:S5-S8, 1997
34. Jacobs MR: Increasing importance of antibiotic-resistant Streptococcus pneumoniae in acute otitis media. Pediatr Infect Dis J 15:940-943, 1996
35. Dagan R, Leibovitz E, Greenberg D, et al: Early eradication of pathogens from middle ear fluid during antibiotic treatment of acute otitis media is associated with improved clinical outcome. Pediatr Infect Dis J 17:776-782, 1998
36. Ubukata K, Shibasaki Y, Yamamoto K: Association of amino acid substitutions in penicillin-binding protein 3 with beta-lactam resistance in beta-lactamase-negative ampicillin-resistant Haemophilus influenzae. Antimicrob Agents Chemother 45:1693-1699, 2001
37. Peric M, Bozdogan B, Jacobs MR, et al: Effects of an efflux mechanism and ribosomal mutations on macrolide susceptibility of Haemophilus influenzae clinical isolates. Antimicrob Agents Chemother 47, 2003
38. Sanchez L, Leranoz S, Puig M, et al: Molecular basis of antimicrobial resistance in non-typable Haemophilus influenzae. Microbiologia 13:309-314, 1997
39. McCracken GH Jr: Etiology and treatment of pneumonia. Pediatr Infect Dis J 19:373-377, 2000
40. Baquero F: Trends in antibiotic resistance of respiratory pathogens: an analysis and commentary on a collaborative surveillance study. J Antimicrob Chemother 38:117-132, 1996 (suppl A)
41. Poole MD, Jacobs MR, Anon JB, et al: Antimicrobial guidelines for the treatment of acute bacterial rhinosinusitis in immunocompetent children. Int J Pediatr Otorhinolaryngol 63:1-13, 2002
42. Jacobs MR, Weinberg W: Evidence-based guidelines for treatment of bacterial respiratory tract infections in the era of antibiotic resistance. Manag Care Interface 14:68-80, 2001
43. Dowell SF, Schwartz B, Phillips WR: Appropriate use of antibiotics for URIs in children: Part II. Cough, pharyngitis and the common cold. The Pediatric URI Consensus Team. Am Fam Physician 58:1335-1342, 1345, 1998
44. Block SL: Causative pathogens, antibiotic resistance and therapeutic considerations in acute otitis media. Pediatr Infect Dis J 16:449-456, 1997
45. Shulman ST: Complications of streptococcal pharyngitis. Pediatr Infect Dis J 13:S70-S74; discussion S78-S79, 1994
46. Schito GC, Georgopoulos A, Prieto J: Antibacterial activity of oral antibiotics against community-acquired respiratory pathogens from three European countries. J Antimicrob Chemother 50:7-11, 2002 (suppl)
47. Kaplan EL, Johnson DR, Del Rosario MC, et al: Susceptibility of group A beta-hemolytic streptococci to thirteen antibiotics: examination of 301 strains isolated in the United States between 1994 and 1997. Pediatr Infect Dis J 18:1069-1072, 1999
48. Martin JM, Green M, Barbadora KA, Wald ER: Erythromycin-resistant group A streptococci in schoolchildren in Pittsburgh. N Engl J Med 346:1200-1206, 2002
49. Linder JA, Stafford RS: Erythromycin-resistant group A streptococci. N Engl J Med 347:614-615; author reply 614-615, 2002
50. Principi N, Esposito S, Blasi F, et al: Role of Mycoplasma pneumoniae and Chlamydia pneumoniae in children with community-acquired lower respiratory tract infections. Clin Infect Dis 32:1281-1289, 2001
51. Falck G, Gnarpe J, Gnarpe H: Prevalence of Chlamydia pneumoniae in healthy children and in children with respiratory tract infections. Pediatr Infect Dis J 16:549-554, 1997
52. Fischer JE, Steiner F, Zucol F, et al: Use of simple heuristics to target macrolide prescription in children with community-acquired pneumonia. Arch Pediatr Adolesc Med 156:1005-1008, 2002
53. McIntosh K: Community-acquired pneumonia in children. N Engl J Med 346:429-437, 2002
54. Esposito S, Bosis S, Cavagna R, et al: Characteristics of Streptococcus pneumoniae and atypical bacterial infections in children 2-5 years of age with community-acquired pneumonia. Clin Infect Dis 35:1345-1352, 2002
55. Forgie IM, O'Neill KP, Lloyd-Evans N, et al: Etiology of acute lower respiratory tract infections in Gambian children: II. Acute lower respiratory tract infection in children ages one to nine years presenting at the hospital. Pediatr Infect Dis J 10:42-47, 1991
56. Mimica I, Donoso E, Howard JE, et al: Lung puncture in the etiological diagnosis of pneumonia. A study of 543 infants and children. Am J Dis Child 122:278-282, 1971
57. Salmenlinna S, Lyytikainen O, Vuopio-Varkila J: Community-acquired methicillin-resistant Staphylococcus aureus, Finland. Emerg Infect Dis 8:602-607, 2002
58. Kak V, Levine DP: Editorial response: Community-acquired methicillin-resistant Staphylococcus aureus infections-where do we go from here? Clin Infect Dis 29:801-802, 1999
59. Zar HJ, Cotton MF: Nosocomial pneumonia in pediatric patients: Practical problems and rational solutions. Paediatr Drugs 4:73-83, 2002
60. Chugh K: Pneumonia due to unusual organisms in children. Indian J Pediatr 66:929-936, 1999
61. Heiskanen-Kosma T, Korppi M, Laurila A, et al: Chlamydia pneumoniae is an important cause of community-acquired pneumonia in school-aged children: serological results of a prospective, population-based study. Scand J Infect Dis 31: 255-259, 1999
62. Juven T, Mertsola J, Waris M, et al: Etiology of community-acquired pneumonia in 254 hospitalized children. Pediatr Infect Dis J 19:293-298, 2000
63. Hall CB, Powell KR, Schnabel KC, et al: Risk of secondary bacterial infection in infants hospitalized with respiratory syncytial viral infection. J Pediatr 113:266-271, 1988
64. Antonow JA, Hansen K, McKinstry CA, et al: Sepsis evaluations in hospitalized infants with bronchiolitis. Pediatr Infect Dis J 17:231-236, 1998
65. Purcell K, Fergie J: Concurrent serious bacterial infections in 2396 infants and children hospitalized with respiratory syncytial virus lower respiratory tract infections. Arch Pediatr Adolesc Med 156:322-324, 2002
66. Benenson, AS: Control of Communicable Diseases Manual, 1995. APHA, Wahington, DC.
67. WHO: The World Health Report 2002. Annex Table 2. Geneva, WHO, 2002
68. Morton R, Mee J: Measles pneumonia: lung puncture findings in 56 cases related to chest X-ray changes and clinical features. Ann Trop Paediatr 6:41-45, 1986
69. Kaschula RO, Druker J, Kipps A: Late morphologic consequences of measles: A lethal and debilitating lung disease among the poor. Rev Infect Dis 5:395-404, 1983
70. Dagan R, Klugman KP, Craig WA, et al: Evidence to support the rationale that bacterial eradication in respiratory tract infection is an important aim of antimicrobial therapy. J Antimicrob Chemother 47:129-140, 2001
71. NCCLS: Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically; approved standard (ed 5). M7-A5 20:17, 2000. NCCLS, Wayne, PA
72. Dagan R, Abramson O, Leibovitz E, et al: Impaired bacteriologic response to oral cephalosporins in acute otitis media caused by pneumococci with intermediate resistance to penicillin. Pediatr Infect Dis J 15:980-985, 1996
73. Dagan R, Abramson O, Leibovitz E, et al: Bacteriologic response to oral cephalosporins: Are established susceptibility breakpoints appropriate in the case of acute otitis media? J Infect Dis 176:1253-1259, 1997
74. Dagan R, Leibovitz E, Leiberman A, et al: Clinical significance of antibiotic resistance in acute otitis media and implication of antibiotic treatment on carriage and spread of resistant organisms. Pediatr Infect Dis J 19:S57-S65, 2000
75. Craig WA: Pharmacokinetic/pharmacodynamic parameters: rationale for antibacterial dosing of mice and men. Clin Infect Dis 26:1-10; quiz 11-2, 1998
76. Jacobs MR: Optimisation of antimicrobial therapy using pharmacokinetic and pharmacodynamic parameters. Clin Microbiol Infect 7:589-596, 2001
77. Drusano GL, Goldstein FW: Relevance of the Alexander project: pharmacodynamic considerations. J Antimicrob Chemother 38:141-154, 1996 (suppl A)
78. Varaldo PE, Debbia EA, Nicoletti G, et al: Nationwide survey in Italy of treatment of Streptococcus pyogenes pharyngitis in children: influence of macrolide resistance on clinical and microbiological outcomes. Artemis-Italy Study Group. Clin Infect Dis 29:869-873, 1999
79. Schito GC, Debbia EA, Marchese A: The evolving threat of antibiotic resistance in Europe: new data from the Alexander Project. J Antimicrob Chemother 46T1:3-9, 2000 (suppl)
80. McMillan JA: Chlamydia pneumoniae revisited. Pediatr Infect Dis J 17:1046-1047, 1998
81. Kastner U, Guggenbichler JP: Influence of macrolide antibiotics on promotion of resistance in the oral flora of children. Infection 29:251-256, 2001
82. Dagan R: Fluoroquinolones in paediatrics-1995. Drugs 49:92-99, 1995
83. Mandell LA, Peterson LR, Wise R, et al: The battle against emerging antibiotic resistance: Should fluoroquinolones be used to treat children? Clin Infect Dis 35:721-7, 2002
84. Jacobs MR: Emergence of antibiotic resistance in upper and lower respiratory tract infections. Am J Manag Care 5:S651-S661, 1999
85. Daly KA: Epidemiology of otitis media. Otolaryngol Clin North Am 24:775-786, 1991
86. Heikkinen T, Thint M, Chonmaitree T: Prevalence of various respiratory viruses in the middle ear during acute otitis media. N Engl J Med 340:260-264, 1999
87. Oguz F, Unuvar E, Dundar G: Evaluation of middle ear fluid in acute otitis media with Gram-stained smear. Pediatr Infect Dis J 21:986-987, 2002
88. Jacobs MR: Increasing antibiotic resistance among otitis media pathogens and their susceptibility to oral agents based on pharmacodynamic parameters. Pediatr Infect Dis J 19:S47-S55; discussion S55-S56, 2000
89. Marchant CD: Acute otitis media, antibiotics, children and clinical trial design. Pediatr Infect Dis J 21:891-893, 2002
90. Marchant CD, Carlin SA, Johnson CE, et al: Measuring the comparative efficacy of antibacterial agents for acute otitis media: the "Pollyanna phenomenon". J Pediatr 120:72-77, 1992
91. Gwaltney JM Jr: Acute community-acquired sinusitis. Clin Infect Dis 23:1209-1223quiz 1224-1225, 1996
92. Dowell SF, Schwartz B, Phillips WR: Appropriate use of antibiotics for URIs in children: Part I. Otitis media and acute sinusitis. The Pediatric URI Consensus Team. Am Fam Physician 58:1113-1118, 1123, 1998
93. Mulholland K: Magnitude of the problem of childhood pneumonia. Lancet 354:590-592, 1999
94. Hoyert DL, Arias E, Smith BL, et al: Deaths: final data for 1999. Natl Vital Stat Rep 49:1-113, 2001
95. Vuori-Holopainen E, Peltola H: Reappraisal of lung tap: review of an old method for better etiologic diagnosis of childhood pneumonia. Clin Infect Dis 32:715-726, 2001
96. Wubbel L, Muniz L, Ahmed A, et al: Etiology and treatment of community-acquired pneumonia in ambulatory children. Pediatr Infect Dis J 18:98-104, 1999
97. Bachur R, Perry H, Harper MB: Occult pneumonias: empiric chest radiographs in febrile children with leukocytosis. Ann Emerg Med 33:166-173, 1999
98. Nelson JD: Community-acquired pneumonia in children: guidelines for treatment. Pediatr Infect Dis J 19:251-253, 2000
99. McCracken GH Jr: Diagnosis and management of pneumonia in children. Pediatr Infect Dis J 19:924-928, 2000
100. Davies HD, Matlow A, Petric M, et al: Prospective comparative study of viral, bacterial and atypical organisms identified in pneumonia and bronchiolitis in hospitalized Canadian infants. Pediatr Infect Dis J 15:371-375, 1996
101. Esposito S, Blasi F, Allegra L, et al: Use of antimicrobial agents for community-acquired lower respiratory tract infections in hospitalised children. Eur J Clin Microbiol Infect Dis 20:647-650, 2001
102. Murphy TF, Henderson FW, Clyde WA Jr, et al: Pneumonia: an eleven-year study in a pediatric practice. Am J Epidemiol 113:12-21, 1981
103. Eskola J, Kilpi T, Palmu A, et al: Efficacy of a pneumococcal conjugate vaccine against acute otitis media. N Engl J Med 344:403-409, 2001
104. Shinefield H, Black H, Elvin L, et al: Impact of the introduction of pneumococcal conjugate vaccine on the epidemiology of invasive disease in children less than five years of age within Northern California Kaiser Permanente (NCKP). 3rd World Congress of Pediatric Infectious Diseases-WSPID, Santiago, Chile, November 2002
105. Shinefield HR, Black S: Efficacy of pneumococcal conjugate vaccines in large scale field trials. Pediatr Infect Dis J 19:394-397, 2000
106. Mofenson LM, Yogev R, Korelitz J, et al: Characteristics of acute pneumonia in human immunodeficiency virus-infected children and association with long term mortality risk. National Institute of Child Health and Human Development Intravenous Immunoglobulin Clinical Trial Study Group. Pediatr Infect Dis J 17:872-880, 1998
107. Madhi SA, Petersen K, Madhi A, et al: Increased disease burden and antibiotic resistance of bacteria causing severe community-acquired lower respiratory tract infections in human immunodeficiency virus type 1-infected children. Clin Infect Dis 31:170-176, 2000
108. McSherry GD: Human immunodeficiency-virus-related pulmonary infections in children. Semin Respir Infect 11:173-183, 1996
109. Silverman M, Stratton D, Diallo A, et al: Diagnosis of acute bacterial pneumonia in Nigerian children. Value of needle aspiration of lung of countercurrent immunoelectrophoresis. Arch Dis Child 52:925-931, 1977
110. Harris JA, Kolokathis A, Campbell M, et al: Safety and efficacy of azithromycin in the treatment of community-acquired pneumonia in children. Pediatr Infect Dis J 17:865-871, 1998
111. Joloba ML, Windau A, Bajaksouzian S, et al: Pneumococcal conjugate vaccine serotypes of Streptococcus pneumoniae isolates and the antimicrobial susceptibility of such isolates in children with otitis media. Clin Infect Dis 33:1489-1494, 2001
112. Whitney CG, Farley MM, Hadler J, et al: Decline in invasive pneumococcal disease after the introduction of protein-polysaccharide conjugate vaccine. N Engl J Med 348:1737-1746, 2003
113. Hoellman DB, Lin G, Jacobs MR, et al: Anti-pneumococcal activity of gatifloxacin compared with other quinolone and non-quinolone agents. J Antimicrob Chemother 43:645-649, 1999
114. Jacobs MR, Appelbaum PC: Streptococcus pneumoniae: Activity of newer agents against penicillin-resistant strains. Curr Infect Dis Rep 1:13-21, 1999
115. Pankuch GA, Hoellman DB, Jacobs MR, et al: Antipneumococcal activity of MEN 10700, a new penem, compared with other compounds, by MIC and time-kill kinetics. J Antimicrob Chemother 44:381-384, 1999
116. Pankuch GA, Visalli MA, Jacobs MR, et al: Susceptibilities of penicillin- and erythromycin-susceptible and - resistant pneumococci to HMR 3647 (RU 66647), a new ketolide, compared with susceptibilities to 17 other agents. Antimicrob Agents Chemother 42:624-630, 1998
117. Pankuch GA, Davies TA, Jacobs MR, et al: Antipneumococcal activity of ertapenem (MK-0826) compared to those of other agents. Antimicrob Agents Chemother 46:42-46, 2002