title: Characteristics and antibiotic therapy of adult meningitis due to penicillin-resistant pneumococci.
abstract: Of 66 episodes of pneumococcal meningitis seen in Bellvitge Hospital, Barcelona, Spain (January 1981 to June 1987), 15 (23 percent) were due to penicillin-resistant pneumococci [minimal inhibitory concentrations (MICs) of 0.1 to 4 micrograms/ml]. Fifty percent of these strains were also resistant to chloramphenicol. Most were sporadic community-acquired cases. Clinical characteristics were similar in both penicillin-resistant and penicillin-sensitive cases. Those cases with MICs of greater than 1 microgram/ml did not show a response to penicillin therapy. Of nine patients treated with cefotaxime (200 to 350 mg/kg per day) with penicillin G MICs of 0.1 to 4 micrograms/ml and cefotaxime MICs of less than or equal to 0.03 to 1 microgram/ml, seven recovered, one experienced a relapse after 14 days of therapy and the infection was cured with intravenous vancomycin, and one patient died with sterile cerebrospinal fluid. Thus, adults with meningitis due to penicillin-resistant pneumococci may be adequately treated with high doses (around 300 mg/kg per day) of intravenous cefotaxime if MICs of penicillin G are less than or equal to 4 micrograms/ml. Cases with higher resistance may require another antibiotic such as vancomycin.
authors: Department of Medicine, Bellvitge Princeps d'Espanya Hospital, Barcelona, Spain.
authors: P F
authors: PF
authors: Viladrich
authors: F
authors: F
authors: Gudiol
authors: J
authors: J
authors: Liñares
authors: G
authors: G
authors: Rufi
authors: J
authors: J
authors: Ariza
authors: R
authors: R
authors: Pallares
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002439:Cefotaxime / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008586:Meningitis, Pneumococcal / Q000188:drug therapy*; D008826:Microbial Sensitivity Tests; D010400:Penicillin G / Q000627:therapeutic use; D010403:Penicillin Resistance; D013296:Streptococcus pneumoniae / Q000187:drug effects*
chemical_list: D000900:Anti-Bacterial Agents; D002439:Cefotaxime; D010400:Penicillin G