Antibiotic-resistant pneumococci are increasing in prevalence in the United States and are present in numerous areas of the country. Simple screening methods available to identify penicillin-resistant strains and improved national surveillance programs should give more accurate data on the frequency that these resistant pneumococci are causing disease. It is logical to assume that, as the prevalence of nasopharyngeal carriage of these strains increases, more and more invasive infections in children will be caused by antibiotic-resistant pneumococci in the future. The treatment of invasive infections, particularly meningitis, caused by penicillin-resistant and multiply resistant strains, and the treatment of AOM caused by pneumococci resistant to all currently available oral preparations remains problematic. Controlled studies are necessary to determine optimal antimicrobials or other interventions necessary to treat these infections. Finally, prevention of colonization and subsequent infection by the pneumococcus assumes new urgency as antimicrobial resistance spreads. Potentially effective vaccines, such as the new polysaccharide-protein conjugate vaccines that will have efficacy in small children, are currently in early field trials and ultimately may be the best mechanism to deal with the spread of these organisms.