DISCEASES

Streptococcus pneumoniae

Fully resistant and multiple-drug resistant pneumococci were discovered in South Africa in 1978. The pattern of emergence of pneumococcal resistance in South Africa has been somewhat different from that observed in Western Europe (and more recently in the United States). In those countries, the emergence of resistance was explosive and associated with a limited number of clones, particularly of serotype 23F and 6B, which are associated with multidrug resistance and high-level penicillin resistance. The highly resistant strains initially isolated in South Africa belonged largely to serotype 19A and for some as yet unexplained reason, remain rare. Antimicrobial resistance to penicillin in the pneumococcus in South Africa has reached very high levels (approximately 45% in young children), but most of this resistance is caused by a large number of intermediately penicillin-resistant strains rather than a limited number of clones found internationally. Antibiotic resistance differs in the public versus private health-care sectors of South Africa. The most important difference may be the relative scarcity of macrolide resistance among strains of pneumococci in public hospitals, where these drugs are less often used.