High doses of cefotaxime in treatment of adult meningitis due to Streptococcus pneumoniae with decreased susceptibilities to broad-spectrum cephalosporins

Viladrich, Pedro F.; Cabellos, Carmen; Pallarés, Román; Tubau, Fé; Martinez‐Lacasa, Javier; Liñares, Josefina; Gudiol, Francisco

doi:10.1128/aac.40.1.218

Cited by 76 publications

(30 citation statements)

References 21 publications

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“…In our study, however, only 1 of 4 patients with cefotaxime-resistant PE (all of whom had a cefotaxime MIC of 1 mg/mL) and meningitis died, and the result of her CSF culture was already negative on the third day that she received high-dose cefotaxime therapy. These results agree with those of a small study in which 7 episodes of pneumococcal meningitis caused by isolates with decreased susceptibility to cefotaxime (MICs of 1 mg/mL for 5 episodes and 2 mg/mL for 2 episodes) were successfully treated with high doses of cefotaxime [41]. Nevertheless, our results should be considered with caution because of the low number of patients with meningitis who have cefotaxime-resistant isolates.…”

Section: Discussionsupporting

confidence: 92%

Effect of Penicillin Resistance ofStreptococcus pneumoniaeon the Presentation, Prognosis, and Treatment of Pneumococcal Endocarditis in Adults

et al. 2002

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We performed a clinical study of pneumococcal endocarditis (PE) in adults at 15 major Spanish hospitals during a 21-year period (1978-1998). During this time, 63 patients had PE due to Streptococcus pneumoniae diagnosed. Of the 63 isolates recovered from these patients, 24 (38%) and 6 (10%) showed resistance to penicillin (minimum inhibitory concentration [MIC], 0.1-4 microg/mL) and cefotaxime (MIC, 1 microg/mL), respectively. Twenty-two (35%) of the patients died. Left-side heart failure, but not penicillin resistance, was independently associated with a higher risk of death (odds ratio, 1.33; 95% confidence interval, 1.04-1.71; P=.026). Patients without meningitis who had PE due to penicillin-resistant S. pneumoniae could be treated with high-dose penicillin or a third-generation cephalosporin if the MIC for penicillin was < or =1 microg/mL. For patients with concurrent meningitis, high doses of cefotaxime could be used if the MIC for cefotaxime was < or =1 microg/mL. Early recognition of heart failure and surgery may help to decrease mortality.

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Section: Discussionsupporting

confidence: 92%

Effect of Penicillin Resistance ofStreptococcus pneumoniaeon the Presentation, Prognosis, and Treatment of Pneumococcal Endocarditis in Adults

et al. 2002

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“…To this day, in parts of the world with the worst resistance problems, surveillance studies in hospitalized CAP patients show that if drugs are dosed appropriately, no significant mortality difference exists between patients treated with a drug or combination of drugs that have a susceptible isolate and those with a resistant one [12,13•,14]. This result has been demonstrated not only in CAP patients but even in patients with meningeal disease, which is inherently harder to treat and from which it is harder to fully recover [15].…”

Section: Introductionmentioning

confidence: 89%

Regulatory disincentives for developing antibiotics for common indications?

Amsden

2007

Curr Infect Dis Rep

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Pediatric and adult community-acquired respiratory tract infections remain some of the most common reasons for visits to primary care practitioners, and the antibiotics used to treat them are historically highly profitable for their manufacturers. Despite these facts and the continued evolving need for new treatments for these infections, virtually no new agents have been developed in the past decade. This review explores some regulatory guidelines that could potentially explain the dearth of development, and it provides some practical answers for resolving them.

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“…However, treatment failures with the thirdgeneration cephalosporins have been reported, and pneumococcal strains resistant to these agents (MIC≥ 2.0 μg/mL) have also been described. When the organism's MIC to a third-generation cephalosporin is ≤1.0 μg/mL, some patients have been successfully treated with high-dose cefotaxime or ceftriaxone; one study also found that high-dose cefotaxime had reliably sufficient CSF bactericidal activity against cephalosporinresistant pneumococci [11].…”

Section: Cephalosporinsmentioning

confidence: 98%

Treatment of Drug-resistant Pneumococcal Meningitis

Hameed

Tunkel

2010

Curr Infect Dis Rep

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The approach to therapy in patients with pneumococcal meningitis has changed considerably over the past 20 years. Given the emergence of pneumococcal strains that are intermediately susceptible or highly resistant to penicillin, penicillin is not recommended as empiric therapy for presumed pneumococcal meningitis; the combination of vancomycin and a third-generation cephalosporin (either cefotaxime or ceftriaxone) should be used, pending isolation of the organism and in vitro susceptibility testing. For patients with pneumococcal meningitis caused by highly penicillin- or cephalosporin-resistant strains, the addition of rifampin can be considered if the organism is susceptible in vitro, the expected clinical or bacteriologic response is delayed, or the pneumococcal isolate has a cefotaxime or ceftriaxone minimal inhibitory concentration greater than 4 μg/mL. Meropenem is not a good option for monotherapy of highly penicillin- or cephalosporin-resistant strains, but use of a fluoroquinolone with in vitro activity against Streptococcus pneumoniae (specifically moxifloxacin) is an option in patients failing standard therapy; if used, however, it should be combined with a third-generation cephalosporin or vancomycin. Newer glycopeptides, daptomycin, and linezolid require further study to determine their efficacy in patients with pneumococcal meningitis.

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High doses of cefotaxime in treatment of adult meningitis due to Streptococcus pneumoniae with decreased susceptibilities to broad-spectrum cephalosporins

Cited by 76 publications

References 21 publications

Effect of Penicillin Resistance ofStreptococcus pneumoniaeon the Presentation, Prognosis, and Treatment of Pneumococcal Endocarditis in Adults

Effect of Penicillin Resistance ofStreptococcus pneumoniaeon the Presentation, Prognosis, and Treatment of Pneumococcal Endocarditis in Adults

Regulatory disincentives for developing antibiotics for common indications?

Treatment of Drug-resistant Pneumococcal Meningitis

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