Treatment of Penicillin- and Cephalosporin-Resistant Pneumococcal Meningitis

High-dose cefotaxime appears to be a good empiric choice for drug-resistant pneumococcal meningitis, but penicillin, ampicillin, or vancomycin are not.

Penicillin- and cephalosporin-resistant Streptococcus pneumoniae is a global health concern with varying regional severity. Because high-quality clinical data on optimal therapy are sparse, expert opinion and animal models are the main drivers of treatment guidelines.

Cabellos et al. conducted an observational study of 339 patients admitted with pneumococcal meningitis between 1977 and 2018 at a single hospital in Spain. A total of 93 cases were penicillin-resistant, of which 35 also were cefotaxime-resistant as defined by EUCAST criteria. Death occurred in 69 cases and treatment failure or relapse in 9 cases. Penicillin- and cefotaxime-resistance were not associated with mortality. Glucocorticoids (administered from 1987 onward) were used i…

Reviewing Author

George Sakoulas, MD

Disclosures

Consultant/Advisory BoardParatek Pharmaceuticals; Nestle Corp.; AbbVie; Shionogi

Speaker’s BureauAllergan/AbbVie; Paratek Pharmaceuticals; Nestle Corp.

RoyaltiesUpToDate

Editorial BoardsAntimicrobial Agents and Chemotherapy; Open Forum Infectious Diseases