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August 27, 1982

Penicillin-Resistant Bacteroides melaninogenicus

JAMA. 1982;248(8):925. doi:10.1001/jama.1982.03330080015017

To the Editor.—  The choice of antimicrobial therapy for anaerobic lung infections remains controversial. These infections usually result from penicillin-sensitive oral flora. However, isolates of penicillin-resistant Bacteroides fragilis and Bacteroides melaninogenicus from such cases have been reported.1 Despite these resistant organisms, several reports have indicated that such infections may respond as well to penicillin as to clindamycin or other antimicrobial drugs directed against the penicillin-resistant species.2We recently treated a cavitating anaerobic pneumonia that did not respond to penicillin or to ampicillin in one of our patients. Clinical response occurred only after administration of clindamycin phosphate was begun.

Report of a Case.—  A 68-year-old diabetic man had development of rigors, fever, and a productive cough. After seven days of illness, a chest roentgenogram disclosed a right lower lobe pneumonia. After hospitalization, intravenous (IV) administration of penicillin G sodium, 600,000 units every six hours for four days, followed by