Meningitis With Beta-Lactam-Resistant Streptococcus Pneumoniae

Kleiman, Martin B.; Weinberg, Geoffrey A.; Reynolds, Janet K.; Allen, Stephen D.

doi:10.1097/00006454-199309000-00019

Cited by 44 publications

(8 citation statements)

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“…Many reports have focused on treatment failures of pneumococcal meningitis associated with decreased susceptibility to the extendedspectrum cephalosporins. [21][22][23][24][25][26] Most experts recommend including vancomycin, a drug generally effective in treating meningitis attributable to pneumococcal isolates that are resistant to cefotaxime or ceftriaxone, in the initial empiric regimen selected when treating a child with suspected bacterial meningitis. 9,10,27 In the 3-year surveillance period of our study, the frequency of penicillin resistance and ceftriaxone resistance increased steadily among the systemic isolates recovered from children.…”

Section: Discussionmentioning

confidence: 99%

Three-Year Multicenter Surveillance of Systemic Pneumococcal Infections in Children

et al. 1998

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The percentage of pneumococcal isolates nonsusceptible to penicillin and ceftriaxone increased yearly among strains recovered from children with systemic infection. Because empiric antibiotic therapy already has changed for suspected pneumococcal infections, antibiotic resistance has not been associated with increased mortality. Careful monitoring of antibiotic susceptibility and outcome of therapy is necessary to continually reassess current recommendations for treatment.

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Section: Discussionmentioning

confidence: 99%

Three-Year Multicenter Surveillance of Systemic Pneumococcal Infections in Children

et al. 1998

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“…74 These concentrations are similar to those reported previously in the absence of dexamethasone. 9,25,51 If dexamethasone is administered, careful and frequent observation of the patient is indicated. 65 Rifampin levels in the CSF were 0.3 to 1.9 g/mL.…”

Section: Use Of Dexamethasone For Patients With Pneumococcal Meningitismentioning

confidence: 99%

“…75 The vancomycin levels in the CSF were 2.0 to 5.9 g/mL and represent 20% of serum levels, 32 much better than the 3% penetration reported for the animal model. 28,51,59 32 The CSF of children who received dexamethasone and the antibiotic combinations of ceftriaxone plus vancomycin or ceftriaxone plus rifampin, when incubated in vitro with pneumococcal strains resistant to ceftriaxone, had significantly enhanced bactericidal activity when compared with the CSF from a child who received dexamethasone and ceftriaxone alone, indicating a significantly enhanced effect from either combination.…”

Section: Use Of Dexamethasone For Patients With Pneumococcal Meningitismentioning

confidence: 99%

Therapy for Children With Invasive Pneumococcal Infections

Halsey¹,

Chesney²,

Gerber³

et al. 1997

Pediatrics

157

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“…How or whether dexamethasone affects the treatment of bacterial meningitis in these patients is unknown. To date, three of eight patients in whom cefotaxime or ceftriaxone treatment for pneumococcal meningitis failed had received adjunctive therapy with dexamethasone [26]. In other cases, prolonged dexamethasone administration has been associated with CSF cultures that remain persistently positive for S. pneumoniae in otherwise healthy children who have been appropriately treated for meningitis [27].…”

Section: Opposing Viewmentioning

confidence: 99%

Steroid Therapy for Bacterial Meningitis

Schaad

Kaplan

McCracken

1995

Clinical Infectious Diseases

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Routine dexamethasone therapy for bacterial meningitis in pediatric patients is controversial. Two experts debated this topic at the 1993 meeting of the Infectious Diseases Society of America. Both experts agreed that for management of Haemophilus influenzae meningitis, dexamethasone significantly reduced sensorineural hearing loss and probably reduced other long-term sequelae. Because relatively few patients with pneumococcal and meningococcal meningitis have been studied, no conclusions could be reached regarding the effectiveness of dexamethasone. Dr. Urs Schaad emphasized the impressive anti-inflammatory effects of dexamethasone in experimental pneumococcal meningitis and the lack of any adverse events when given to children for 2 or 4 days. He recommended routine use of dexamethasone in treating pediatric patients with bacterial meningitis. Dr. Sheldon Kaplan expressed concern regarding the effectiveness of steroids in treating pneumococcal meningitis, especially when penicillin-resistant and cephalosporin-resistant isolates are present, and he addressed the question of the long-term effects of administration of dexamethasone in children with viral meningitis. He advised against the routine use of dexamethasone for non-H. influenzae meningitis.At the annual meeting of the Infectious Diseases Society of America in October 1993, one of the sessions was devoted to the controversy of whether dexamethasone should be routinely used to treat patients with bacterial meningitis. The two physicians chosen to address this issue had recently conducted multicenter, placebo-controlled, double-blind studies of dexamethasone therapy in children with meningitis. Dr. Urs B. Schaad was asked to present information supporting the routine use of dexamethasone therapy in these patients. Dr. Sheldon L. Kaplan took the opposing view-that dexamethasone should be used only in select patients with bacterial meningitis. The following paper represents a distillation of their presentations and a commentary by Dr. George H. McCracken, Jr. Affirmative ViewBacterial meningitis remains an important cause of death and permanent neurological disability despite advances in antimicrobial therapy, rapid diagnostic techniques, and sup- Data from recent in vitro and animal experiments indicate that the bacteria causing meningitis elaborate outer membrane-active or cell wall-active components that affect monocytes, leukocytes, cerebrovascular endothelial cells, and astrocytes [1][2][3]. These cells, in turn, produce various proinflammatory cytokines or express specific receptors on their surface. These cytokines and receptors initiate an accelerating cascade of events, resulting in alteration of the bloodbrain barrier, meningeal inflammation, increased intracranial pressure, and decreased cerebral vascular perfusion. If the interaction of these pathopysiological alterations is severe and sustained, it will produce neuronal injury and irreversible focal or diffuse brain damage.Dexamethasone is a potent antiinflammatory agent. There is convincing in ...

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Meningitis With Beta-Lactam-Resistant Streptococcus Pneumoniae

Cited by 44 publications

References 0 publications

Three-Year Multicenter Surveillance of Systemic Pneumococcal Infections in Children

Three-Year Multicenter Surveillance of Systemic Pneumococcal Infections in Children

Therapy for Children With Invasive Pneumococcal Infections

Steroid Therapy for Bacterial Meningitis

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