Treatment failure with use of a third-generation cephalosporin for penicillin-resistant pneumococcal meningitis

Case report and review

Research output: Contribution to journalArticle

178 Citations (Scopus)

Abstract

Recent reports have documented the increasing number of pneumococcal isolates that are relatively or completely resistant to penicillin and other antibiotics. This report documents a case in which third-generation cephalosporin failed in the treatment of pneumococcal meningitis and reviews the clinical and microbiological features of the seven similar cases reported to date. In all eight cases, the pneumococci were penicillin resistant. Taken together, these cases suggest that (1) children with intermediately penicillin-resistant pneumococcal meningitis (MIC, 0.1-1.0 μg/mL) who are treated with cefotaxime or ceftriaxone should be observed carefully for treatment failure and (2) children with highly penicillin-resistant pneumococcal meningitis (MIC, ≥2.0 μg/mL) are best treated with vancomycin and rifampin until the MICs of cefotaxime and ceftriaxone for the pneumococcus are known.

Original languageEnglish (US)
Pages (from-to)188-193
Number of pages6
JournalClinical Infectious Diseases
Volume18
Issue number2
StatePublished - Feb 1994
Externally publishedYes

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Pneumococcal Meningitis
Cephalosporins
Treatment Failure
Cefotaxime
Ceftriaxone
Streptococcus pneumoniae
Penicillins
Vancomycin
Rifampin
Therapeutics

ASJC Scopus subject areas

  • Immunology

Cite this

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abstract = "Recent reports have documented the increasing number of pneumococcal isolates that are relatively or completely resistant to penicillin and other antibiotics. This report documents a case in which third-generation cephalosporin failed in the treatment of pneumococcal meningitis and reviews the clinical and microbiological features of the seven similar cases reported to date. In all eight cases, the pneumococci were penicillin resistant. Taken together, these cases suggest that (1) children with intermediately penicillin-resistant pneumococcal meningitis (MIC, 0.1-1.0 μg/mL) who are treated with cefotaxime or ceftriaxone should be observed carefully for treatment failure and (2) children with highly penicillin-resistant pneumococcal meningitis (MIC, ≥2.0 μg/mL) are best treated with vancomycin and rifampin until the MICs of cefotaxime and ceftriaxone for the pneumococcus are known.",
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