INFECTIOUS DISEASES: Edited by Alimuddin Zumla and Michael S. NiedermanTargeting antimicrobial-resistant bacterial respiratory tract pathogens it is time to ‘get smart’Lee, Boeun; Boucher, Helen W.Author Information Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, USA Correspondence to Helen W. Boucher, MD, FACPFIDSA, Director, Infectious Diseases Fellowship Program, Associate Professor of Medicine, Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, 800 Washington Street, Box 238, Boston, MA 02111, USA. Tel: +1 617 636 3010; fax: +1 617 636 8525; e-mail: [email protected] Current Opinion in Pulmonary Medicine: May 2015 - Volume 21 - Issue 3 - p 293-303 doi: 10.1097/MCP.0000000000000157 Buy Metrics Abstract Purpose of review Pathogen-directed therapy targeting multidrug-resistant bacteria in pneumonia can be a challenge. We reviewed the recent literature on bacterial resistance, diagnostic methods, and treatment strategies to guide pathogen-directed therapy of respiratory infections. Recent findings Antibiotic resistance is a growing problem in both community and nosocomial settings. Macrolide resistance in Streptococcus pneumoniae varies geographically, ranging from 45 to 88%, and has been associated with prior antibiotic use. Methicillin-resistant Staphylococcus aureus and multidrug-resistant Gram-negative bacilli remain the main targets for pathogen-directed therapy in patients with hospital-acquired and ventilator-associated pneumonia. Rapid molecular tests show promise to facilitate pathogen-directed therapy. Improved antibiotic use with the right drug and optimal dose is a key strategy in tackling antimicrobial resistance. Evidence supporting de-escalation for hospital-acquired and ventilator-associated pneumonia has been increasing. To date, no convincing evidence exists to support combination therapy for severe infections due to carbapenem-resistant Gram-negative bacilli. Aerosolized therapy might provide additive benefits to parenteral therapy, but requires further study. Summary Pathogen-directed therapy guided by in-vitro microbiological data is a safe approach for the treatment of respiratory infections due to antibacterial-resistant bacteria. Further research should focus on the role of rapid diagnostic tools, new antibiotics, and novel immunotherapy for respiratory infection. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.