Management of pneumococcal meningitis.
During the past decade antibiotic resistance among Streptococcus pneumoniae isolates has complicated the empiric approach to and treatment of pneumococcal meningitis. Standard empiric therapy for suspected bacterial meningitis for infants and children older than 1 month of age is the combination of cefotaxime or ceftriaxone and vancomycin. Treatment is modified after antimicrobial susceptibilities are available. The optimal treatment of pneumococcal meningitis caused by strains with a cefotaxime/ceftriaxone MIC >2 microg/ml is unknown, although the addition of rifampin to the initial combination is generally recommended. The role of newer agents including quinolones is under investigation. Dexamethasone remains the only adjunctive antiinflammatory therapy to consider. The empiric approach to the child with suspected bacterial meningitis who has received the pneumococcal conjugate vaccine currently remains unchanged.
Texas Children's Hospital, Houston, USA.
Sheldon L
SL
Kaplan
D000328:Adult; D002439:Cefotaxime / Q000494:pharmacology / Q000627:therapeutic use; D002443:Ceftriaxone / Q000494:pharmacology / Q000627:therapeutic use; D003907:Dexamethasone / Q000627:therapeutic use; D004351:Drug Resistance; D004359:Drug Therapy, Combination / Q000592:standards / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D008586:Meningitis, Pneumococcal / Q000188:drug therapy* / Q000517:prevention & control; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000472:pathogenicity; D016896:Treatment Outcome; D014640:Vancomycin / Q000494:pharmacology / Q000627:therapeutic use
D014640:Vancomycin; D002443:Ceftriaxone; D003907:Dexamethasone; D002439:Cefotaxime