title: Penicillin and ceftriaxone susceptibility of Streptococcus pneumoniae isolated from cerebrospinal fluid of children with meningitis hospitalized in a tertiary hospital in Israel.
abstract: BACKGROUND
  Streptococcus pneumoniae is now the predominant pathogen causing meningitis. The resistance of S. pneumoniae to penicillin and third-generation cephalosporins has grown steadily.
  
  
  OBJECTIVE
  To assess the antibiotic susceptibility of S. pneumoniae isolated from the cerebrospinal fluid of children with meningitis, and determine the antibiotic regimen appropriate for suspected bacterial meningitis in Israel.
  
  
  METHODS
  The study group included 31 children with 35 episodes of meningitis hospitalized from 1998 to 2006. S. pneumoniae isolates from the cerebrospinal fluid were tested for susceptibility to penicillin and ceftriaxone.
  
  
  RESULTS
  Of the 35 isolates, 17 (48.6%) showed resistance to penicillin (minimum inhibitory concentration > or = 0.12 microg/ml). Only 3 isolates (8.6%) showed intermediate resistance to ceftriaxone (> or = 0.5 and < (2 microg/ml), and none showed complete resistance (MIC > or = 2 microg/ml). The rates of antibiotic resistance were higher in children who were treated with antibiotics prior to admission (penicillin 88.9% vs. 34.6%, P = 0.007; ceftriaxone 22.2% vs. 3.8%, P = 0.156).
  
  
  CONCLUSIONS
  The rate of penicillin resistance is high in children with S. pneumoniae meningitis in Israel, especially in those treated with oral antibiotics prior to admission. Resistance to ceftriaxone is infrequent though not negligible. On the basis of these findings, current recommendations to empirically treat all children with suspected bacterial meningitis with ceftriaxone in addition to vancomycin until the bacterial susceptibility results become available are justified also in Israel.
authors.affiliation: Department of Pediatrics A, Schneider Children's Medical Center of Israel,, Petah Tikva, sity, Israel. oritwz@netvision.net.il
authors.forename: Orith
authors.initials: O
authors.lastname: Waisbourd-Zinman
authors.forename: Efraim
authors.initials: E
authors.lastname: Bilavsky
authors.forename: Naama
authors.initials: N
authors.lastname: Tirosh
authors.forename: Zmira
authors.initials: Z
authors.lastname: Samra
authors.forename: Jacob
authors.initials: J
authors.lastname: Amir
mesh_terms: D000900:Anti-Bacterial Agents / Q000134:cerebrospinal fluid / Q000627:therapeutic use*; D002443:Ceftriaxone / Q000134:cerebrospinal fluid / Q000627:therapeutic use*; D018550:Cephalosporin Resistance; D002648:Child; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007557:Israel; D008297:Male; D008586:Meningitis, Pneumococcal / Q000134:cerebrospinal fluid / Q000188:drug therapy*; D008826:Microbial Sensitivity Tests / Q000379:methods / Q000706:statistics & numerical data; D010403:Penicillin Resistance; D010406:Penicillins / Q000134:cerebrospinal fluid / Q000627:therapeutic use*; D013296:Streptococcus pneumoniae / Q000187:drug effects* / Q000302:isolation & purification; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins; D002443:Ceftriaxone