title: Time-kill studies of antimicrobial combinations including cefotaxime, ceftriaxone, vancomycin and meropenem against cephalosporin-resistant Streptococcus pneumoniae.
abstract: BACKGROUND
  Resistance of Streptococcus pneumoniae to penicillin is now widespread and rapidly increasing all over the world. This has led to the critical need for alternative antimicrobial therapy.
  
  
  METHODS
  To assess the activities of antimicrobial combinations, including cefotaxime, ceftriaxone, vancomycin and meropenem, time-kill studies were conducted against five strains of penicillin- and cephalosporin-resistant S. pneumoniae at clinically achievable antimicrobial concentrations in cerebrospinal fluid.
  
  
  RESULTS
  Combinations of an extended-spectrum cephalosporin with vancomycin were not synergistic. Meropenem had a comparable bactericidal activity to those combinations, and its killing activity was not affected by the addition of cefotaxime, ceftriaxone or vancomycin.
  
  
  CONCLUSIONS
  It is suggested that meropenem could be an effective alternative for the treatment of penicillin- and cephalosporin-resistant pneumococcal meningitis. However, more clinical data are required before it can be recommended as an effective antimicrobial agent for such cases.
authors.affiliation: Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. griuni@chollian.net
authors.forename: B N
authors.initials: BN
authors.lastname: Kim
authors.forename: J H
authors.initials: JH
authors.lastname: Woo
authors.forename: Y S
authors.initials: YS
authors.lastname: Kim
authors.forename: J
authors.initials: J
authors.lastname: Ryu
authors.forename: M N
authors.initials: MN
authors.lastname: Kim
authors.forename: C H
authors.initials: CH
authors.lastname: Pai
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D002439:Cefotaxime / Q000494:pharmacology*; D002443:Ceftriaxone / Q000494:pharmacology*; D018550:Cephalosporin Resistance; D002511:Cephalosporins / Q000494:pharmacology*; D004359:Drug Therapy, Combination; D006801:Humans; D008586:Meningitis, Pneumococcal / Q000188:drug therapy; D000077731:Meropenem; D008826:Microbial Sensitivity Tests; D013290:Streptococcal Infections / Q000188:drug therapy*; D013296:Streptococcus pneumoniae / Q000187:drug effects*; D013845:Thienamycins / Q000494:pharmacology*; D014640:Vancomycin / Q000494:pharmacology*
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D013845:Thienamycins; D014640:Vancomycin; D002443:Ceftriaxone; D000077731:Meropenem; D002439:Cefotaxime