Neisseria meningitidis with reduced sensitivity to penicillin: Observations in 10 Children

Abstract

10/84 strains (11.9%) of Neisseria meningitidis isolated from blood and/or cerebrospinal fluid in children 1986-1987 had reduced sensitivity to benzylpenicillin (MICs 0.1-0.4 mg/l). Group C meningococci predominated among these strains. The clinical course was satisfactory in all cases regardless of the antibiotic treatment used, although the time to abatement of fever was prolonged compared to that of children infected with susceptible strains.

Practice Patterns of Infectious Disease Physicians for Management of Meningococcal Disease

“…[13][14][15][16] Although the clinical significance of N. meningitidis with intermediate susceptibility to penicillin has not been demonstrated, reports of treatment failure in patients infected with these strains are rare, particularly when high-dose penicillin is preceded by 24 hours of empiric treatment with third generation cephalosporins. [17][18][19][20] Besides antimicrobial resistance concerns, the most often indicated reason given by pediatric specialists was the "excellent CSF penetration" of third generation cephalosporins, reflecting concerns about the need to achieve adequate cerebrospinal fluid drug concentrations when treating central nervous system infections. In contrast, the most commonly cited reason among adult specialists who would maintain third generation cephalosporins was cost and feasibility of administration.…”

Three Days of Intravenous Benzyl Penicillin Treatment of Meningococcal Disease in Adults

“…Of the 4 patients, 1 died of fulminant meningococcal disease, and the other 3 were cured. In other studies with small numbers of subjects, treatment with conventional doses of penicillin has remained effective against strains with reduced susceptibility [34,36]. We acknowledge that increasing resistance could change this.…”

Microbiological epidemiological history of meningococcal disease in Rio de Janeiro, Brazil

“…The increase of cases of meningococcal disease caused by PenRR isolates has been followed by publications of only a few reports of treatment failure, some of then inconclusive or just showing a prolonged time to abatement of fever. [55][56][57][58] Accumulating clinical experience has gradually outlined the epidemiology of meningococcal disease, including the epidemic and the endemic disease, the usual clinical signs according to age of patients, and causative strains. 59 Mass vaccination campaign, if appropriately implemented, has been documented to halt an epidemic of meningococcal disease.…”