MACRO SOLUTIONS TO A MICRO PROBLEM: DRUG-RESISTANT PNEUMOCOCCAL PNEUMONIA.

Even before the COVID-19 pandemic, acute respiratory infections represented one of the most common reasons for patients to seek urgent medical care. <i>S. pneumoniae</i> is one of the most frequent bacterial causes of acute respiratory infections, especially community-acquired pneumonia. In the latter part of the twentieth century, the emergence of multidrug resistance among clinical isolates of <i>S. pneumoniae</i> threatened to render standard empiric antibiotic therapy ineffective. One of the biggest drivers of pneumococcal drug resistance is antibiotic overuse, among both adults and children. While the introduction of the pneumococcal conjugate vaccine in 2000 dramatically impacted the overall incidence of pneumococcal pneumonia in both children and adults, the levels of antibiotic resistance have remained significant. To reduce the overuse of antibiotics requires multidimensional interventions targeting patients, clinicians, and health systems. Studies have demonstrated improvement in this area, but the quality gap remains high. Future work will focus on organizational strategies and policies that optimize antibiotic use for patients with antibiotic responsive acute illnesses.