Characteristics and antibiotic therapy of adult meningitis due to penicillin-resistant pneumococci.
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.
Viladrich
P F
PF
Department of Medicine, Bellvitge Princeps d'Espanya Hospital, Barcelona, Spain.
Gudiol
F
F
Liñares
J
J
Rufi
G
G
Ariza
J
J
Pallares
R
R
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*
D000900:Anti-Bacterial Agents; D002439:Cefotaxime; D010400:Penicillin G