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One-third of 57 strains of pneumococci isolated from patients with severe pneumococcal infections in Port Moresby, Papua New Guinea, in 1978 were penicillin-insensitive (PR). The infections were community-acquired and comprised cases of bacteraemia, bacteraemic pneumonia, and meningitis. The prevalence of invasive PR strains in children was significantly greater than in adults.

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Infections due to pneumococci with decreased susceptibility (or resistance) to penicillin have been infrequently recognized. Our experience and that of others suggest that (1) penicillin susceptibility testing of significant pneumococcal isolates should become routine; (2) penicillin may not be adequate therapy for CNS infections due to pneumococci whose penicillin minimal inhibitory concentration is greater than 0.1 microgram/ml; and (3) long-term penicillin "prophylaxis" may be inappropriate in the splenectomized patient in areas where these organisms are prevalent.

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Pneumococci relatively insensitive to penicillin G were isolated from the sputum of two patients with pneumonia. One of the organisms was also relatively insensitive to ampicillin, cefamandole, and cephalothin and was resistant to tetracycline. Because penicillin-insensitive pneumococci are being reported with greater frequency, continued surveillance of pneumococcal sensitivity to penicillin is appropriate.

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Three cases of infection, including two fatal ones, caused by pneumococci relatively resistant to penicillin are reported. The patients were a 19-year-old New Guinean with fatal multisegmental pneumonia, a 10-week-old Caucasian infant who died suddenly from purulent meningitis, and an Australian Aboriginal child aged two years with bronchiectasis complicated by pneumococcal bacteraemia. The pneumococci isolated (serotypes 6, 16 and 19) showed minimal inhibitory concentrations of penicillin G ranging from 0-1 microgram/ml to 1-0 microgram/ml (resistance ratios five to 50) and were also relatively resistant to penicillin V, methicillin, cloxacillin and cephalosporins.

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