title: High doses of cefotaxime in treatment of adult meningitis due to Streptococcus pneumoniae with decreased susceptibilities to broad-spectrum cephalosporins.
abstract: We treated nine patients (10 episodes) with meningitis caused by Streptococcus pneumoniae isolates with decreased susceptibilities to broad-spectrum cephalosporins with high doses of cefotaxime (300 mg/kg of body weight per day; maximum dose, 24 g/day). Early adjunctive therapy with dexamethasone was also administered. Cefotaxime MICs were 0.5 (three episodes), 1 (five episodes), and 2 (two episodes) micrograms/ml, and MBCs ranged from 1 to 4 micrograms/ml. Therapy was well tolerated, and all patients experienced prompt clinical improvement. One patient died 8 days after the end of therapy, the central nervous system infection had already been cured, and the remaining patients recovered without relapses.
authors.affiliation: Infectious Diseases Service, University of Barcelona, Spain.
authors.forename: P F
authors.initials: PF
authors.lastname: Viladrich
authors.forename: C
authors.initials: C
authors.lastname: Cabellos
authors.forename: R
authors.initials: R
authors.lastname: Pallares
authors.forename: F
authors.initials: F
authors.lastname: Tubau
authors.forename: J
authors.initials: J
authors.lastname: Martínez-Lacasa
authors.forename: J
authors.initials: J
authors.lastname: Liñares
authors.forename: F
authors.initials: F
authors.lastname: Gudiol
mesh_terms: D000328:Adult; D000368:Aged; D002439:Cefotaxime / Q000008:administration & dosage / Q000134:cerebrospinal fluid / Q000627:therapeutic use*; D018550:Cephalosporin Resistance; D002511:Cephalosporins / Q000008:administration & dosage / Q000134:cerebrospinal fluid / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008586:Meningitis, Pneumococcal / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D013030:Spain / Q000453:epidemiology
chemical_list: D002511:Cephalosporins; D002439:Cefotaxime