Antibiotic susceptibility in Streptococcus pneumoniae, Haemophilus influenzae and Streptococcus pyogenes in Pakistan: a review of results from the Survey of Antibiotic Resistance (SOAR) 2002–15

April 5, 2016 at 7:57 pm

Journal of Antimicrobial Chemotherapy May 2016 V.71 Suppl 1 i103-i109

Zafar, R. Hasan, S. Nizamuddin, N. Mahmood, S. Mukhtar, F. Ali, I. Morrissey, K. Barker, and D. Torumkuney

1Aga Khan University Hospital, Department of Pathology and Laboratory Medicine, Section of Microbiology, Karachi, Pakistan

2Shaukat Khanum Memorial Cancer Hospital and Research Center, Department of Microbiology, 7A, Block R-3, Johar Town, Lahore, Pakistan

3GlaxoSmithKline Pakistan, 35 Dockyard Road, West Wharf, Karachi 74000, Pakistan

4IHMA Europe Sàrl, 9a route de la Corniche, Epalinges 1066, Switzerland

5GlaxoSmithKline, 980 Great West Road, Brentford, Middlesex TW8 9GS, UK


To investigate changes in the antibiotic susceptibility of Streptococcus pneumoniae, Haemophilus influenzae and Streptococcus pyogenes from the Survey of Antibiotic Resistance (SOAR) in community-acquired respiratory tract infections (CA-RTIs) between 2002 and 2015 in Pakistan.


This is a review based on previously published studies from 2002–03, 2004–06 and 2007–09 and also new data from 2014–15. Susceptibility was determined by Etest® or disc diffusion according to CLSI and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints.


A total of 706 isolates from CA-RTIs comprising 381 S. pneumoniae, 230 H. influenzae and 95 S. pyogenes were collected between 2002 and 2015 and tested against a range of antibiotics. Antibiotic resistance in S. pneumoniae rose steeply from 2002 to 2009, with isolates non-susceptible to penicillin and macrolides increasing from 10% to 34.1% and from 13%–14% to 29.7%, respectively. Susceptibility to amoxicillin/clavulanic acid (and by inference amoxicillin) remained between 99.4% and 100% from 2002 to 2015. Over the years, the prevalence of susceptibility to cefuroxime was 98%–100% among S. pneumoniae. Resistance in S. pneumoniae to some older antibiotics between 2007 and 2009 was high (86.8% for trimethoprim/sulfamethoxazole and 57.2% for tetracycline). Between 2002 and 2015, ampicillin resistance (β-lactamase-positive strains) among H. influenzae has remained low (between 2.6% and 3.2%) and almost unchanged over the years (H. influenzae was not tested during 2004–06). For S. pyogenes isolates, macrolide resistance reached 22%; however, susceptibility to penicillin, amoxicillin/clavulanic acid and cefuroxime remained stable at 100%.


In S. pneumoniae from Pakistan, there has been a clear reduction in susceptibility to key antibiotics since 2002, but not to amoxicillin/clavulanic acid (amoxicillin) or cefuroxime. However, susceptibility in H. influenzae has remained stable. Local antibiotic susceptibility/resistance data are essential to support informed prescribing for CA-RTIs and other infections.



Entry filed under: Antimicrobianos, Bacterias, Bacteriemias, Epidemiología, Infecciones respiratorias, Metodos diagnosticos, Resistencia bacteriana, REVIEWS, Update.

Results from the Survey of Antibiotic Resistance (SOAR) 2009–11 and 2013–14 in China Clinical Performance of Check-Direct CPE, a Multiplex PCR for Direct Detection of blaKPC, blaNDM and/or blaVIM, and blaOXA-48 from Perirectal Swabs


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