Management of Infections Due to Antibiotic-Resistant
            <i>Streptococcus pneumoniae</i>

Kaplan, Sheldon L.; Mason, Edward O.

doi:10.1128/cmr.11.4.628

Cited by 212 publications

(94 citation statements)

References 137 publications

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“…What constitutes the ideal treatment remains a matter of debate but, unlike the situation with pneumonia, there seems to be no controversy among experts that the use of penicillin is no longer acceptable as empiric therapy for patients suspected of having pneumococcal meningitis [3,[39][40][41].…”

Section: Meningitismentioning

confidence: 97%

“…Viladrich et al [41] reported treating seven episodes (six patients) of pneumococcal meningitis caused by isolates with decreased susceptibility to cefotaxime (MIC = 1.0 µg/ml in five episodes and MIC = 2.0 µg/ml in two episodes). Treatment consisted of cefotaxime, 300 mg/kg/day, with a maximum daily dose of 24 grams.…”

Section: Meningitismentioning

confidence: 97%

“…Early reports documented clinical failure in the majority of patients with PNSP meningitis who were treated with penicillin [41]. The achievable CSF concentrations of penicillin seem to be the limiting factor.…”

Section: Meningitismentioning

confidence: 98%

“…Ceftriaxone and cefotaxime are used more frequently than ceftizoxime because the latter is less active, in vitro, against PNSP [43••]. Cefepime has equivalent efficacy to cefotaxime and ceftriaxone in the treatment of pneumococcal meningitis caused by Pen-S strains, although its role in the treatment of PNSP meningitis remains largely undefined [41].…”

Section: Meningitismentioning

confidence: 99%

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Impact of antimicrobial resistance on the treatment of invasive pneumococcal infections

Rocha

Baleeiro

Tunkel

2000

Curr Infect Dis Rep

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Infectious diseases, such as pneumococcal pneumonia, which were almost invariably lethal in the pre-antibiotic era, caused radically less mortality with the advent of antimicrobial chemotherapy. However, the use, misuse, and abuse of these agents have led to the emergence of antimicrobial resistance. In the past, pneumococci were all exquisitely sensitive to penicillin G. By the late 1960s, penicillin-nonsusceptible Streptococcus pneumoniae (PNSP) was being described. Since then, this problem has achieved epidemic proportions in many areas of the world, including the United States. Many experts no longer consider penicillin an acceptable therapy for patients suspected of having invasive pneumococcal disease, especially if the central nervous system (CNS) is involved. Recommendations for therapy are based on theoretical concerns, in vitro susceptibility testing, animal data, and a few, scattered reports of penicillin failure in patients with invasive disease.

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Section: Meningitismentioning

confidence: 97%

Section: Meningitismentioning

confidence: 97%

Section: Meningitismentioning

confidence: 98%

Section: Meningitismentioning

confidence: 99%

See 2 more Smart Citations

Impact of antimicrobial resistance on the treatment of invasive pneumococcal infections

Rocha

Baleeiro

Tunkel

2000

Curr Infect Dis Rep

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“…Worldwide, Streptococcus pneumoniae strains with decreased susceptibility to penicillin and third-generation cephalosporins are emerging as a matter of concern. In 1998 Kaplan and Mason [2] reviewed 16 cases of treatment failure with third-generation cephalosporins in episodes of meningitis caused by cephalosporin-resistant (13 cases) or intermediately susceptible (3 cases) Streptococcus pneumoniae strains. Since that time at least three additional cases have been published [3,4,5].…”

mentioning

confidence: 99%

Failure of Cefotaxime and Meropenem to Eradicate Meningitis Caused by an Intermediately Susceptible Streptococcus pneumoniae Strain

Vandecasteele

Verhaegen

Colaert

et al. 2001

Eur J Clin Microbiol Infect Dis

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During the last decade the epidemiology of bacterial meningitis has changed dramatically. Since the introduction of Haemophilus influenzae type b vaccination for young children, Neisseria meningitidis and Streptococcus pneumoniae have emerged as the major causes of bacterial meningitis both in adults and infants [1]. Worldwide, Streptococcus pneumoniae strains with decreased susceptibility to penicillin and third-generation cephalosporins are emerging as a matter of concern. In 1998 Kaplan and Mason [2] reviewed 16 cases of treatment failure with third-generation cephalosporins in episodes of meningitis caused by cephalosporin-resistant (13 cases) or intermediately susceptible (3 cases) Streptococcus pneumoniae strains. Since that time at least three additional cases have been published [3,4,5]. We report here a case of antibiotic failure that occurred in a patient with Streptococcus pneumoniae meningitis treated with cefotaxime and meropenem. This is the first report of antibiotic failure in the treatment of meningitis in Belgium, and, to the best of our knowledge, the fifth report of treatment failure with thirdgeneration cephalosporins in a strain with only lowlevel resistance.In November 2000 a 7-month-old girl was admitted to a regional hospital with high fever, meningeal irritation and convulsions. The girl had been well until 3 days before admission, when she developed an upper airway infection. One day prior to admission she had received cefuroxime axetil. Treatment with cefotaxime 250 mg/kg divided over six doses, lorazepam and phenobarbital was started directly after admission. Due to intractable seizures and altered consciousness, the patient was transferred to a tertiary care hospital after a few hours. Diazepam and dexamethasone (0.25 mg/kg for 4 days) were added to the treatment regimen.Cerebrospinal fluid (CSF) at admission contained a protein concentration of 1,614 mg/l and a leukocyte count of 6,260 cells/µl. CSF and blood cultures yielded a Streptococcus pneumoniae, capsular type 14 strain. From day 2 until day 5 after admission, the patient's general condition improved, but the meningeal irritation was slow to disappear. The girl was transferred back to the regional hospital on day 5. She continued to have a fever (39-40°C) without other clinical symptoms. Given the possibility of drug-induced fever, and in view of the reduced susceptibility of the strain to cefotaxime, the treatment was switched to meropenem (110 mg/kg/d) on day 6. On day 8 the patient's level of consciousness deteriorated. Therefore, a second lumbar puncture was performed. The CSF demonstrated a protein concentration of 1,255 mg/l and a leukocyte count of 2,750 cells/µl. Gram staining of the CSF showed rare, gram-positive cocci in chains, and culture grew Streptococcus pneumoniae, capsular type 14. Vancomycin (40 mg/kg/d) was added to the treatment regimen. The fever and meningeal irritation resolved quickly. On day 16 a third lumbar puncture was performed, and culture of the CSF was sterile. The girl was discharged on day 22...

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Difficulties in the diagnosis and treatment of acute lower respiratory tract infections in uruguay

Sarachaga¹

2001

Pediatr. Pulmonol.

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Management of Infections Due to Antibiotic-Resistant Streptococcus pneumoniae

Cited by 212 publications

References 137 publications

Impact of antimicrobial resistance on the treatment of invasive pneumococcal infections

Impact of antimicrobial resistance on the treatment of invasive pneumococcal infections

Failure of Cefotaxime and Meropenem to Eradicate Meningitis Caused by an Intermediately Susceptible Streptococcus pneumoniae Strain

Difficulties in the diagnosis and treatment of acute lower respiratory tract infections in uruguay

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