Meningitis Due to Ceftriaxone-ResistantStreptococcus pneumoniae

Abstract

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Streptococcus pneumoniae: Does Antimicrobial Resistance Matter?

“…In the late 1980s and early 1990s, reports of therapeutic failures with cephalosporins for meningitis due to CEPH-resistant pneumococci were published. 42,43,180,[210][211][212][213][214][215][216] In light of the escalating b-lactam resistance, by the mid-to late-1990s the combination of vancomycin in addition to cefotaxime or ceftriaxone was considered standard care for pneumococcal meningitis. 189,193,194 However, there is no strong evidence that outcomes are worse among patients with CEPHresistant pneumococci.…”

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

“…To date, the clinical experience in treating cephalosporinresistant pneumococcal meningitis is very limited, and its most appropriate therapy is not yet well known. Besides other suggested alternatives (6,8,9,18,22,23,28), the possibility of overcoming the problem of decreased cephalosporin susceptibility by increasing the dosage in order to achieve higher antibiotic levels in CSF deserves attention. The experience with high-dose cefotaxime that we have reported here has been fully satisfactory, and if it is confirmed by further studies, it might allow for the continuing use of cefotaxime, but in a high-dose regimen, as first-line empiric therapy for suspected adult pneumococcal meningitis.…”

Prevention of pneumococcal meningitis

“…In addition, many penicillinresistant pneumococci have also become resistant to other antimicrobial agents including erythromycin, clarithromycin, azithromycin, trimethoprim-sulfamethoxazole, clindamycin, the fluoroquinolones, and the extended-spectrum parenteral third-generation cephalosporins such as ceftriaxone and cefotaxime, which further increases the complexity of treatment [24••,34]. This is especially true for pneumococcal meningitis where an increasing number of cases of treatment failure are being reported with isolates that are found to be resistant to the extended-spectrum parenteral third-generation cephalosporins; consequently, the use of alternative antimicrobial regimens is becoming much more commonplace [35][36][37][38][39][40][41]. These case reports also suggest that clinical outcome may be worse in those patients infected with highly resistant strains due primarily to ongoing infection and delay in sterilization of the CSF.…”