What are the antibiotics of last resort for the treatment
of macrolide resistant, penicillin and multi-drug resistant
S. pneumoniae? Currently, they are linezolid and vancomycin.
Unlike S. aureus and enterococci vancomycin-resistant
S. pneumoniae have not yet been identified. However,
clinical strains of vancomycin tolerant S. pneumoniae have
been identified [41,42]. Tolerance is the ability of bacteria
to survive in the presence of an antibiotic, neither
growing nor undergoing lysis. It is thought to be a precursor
to resistance development. As vancomycin tolerance
is not routinely documented in the surveillance
studies as with macrolide resistance it is difficult to
identify the full extent of vancomycin tolerance.