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[Vancomycin in meningitis caused by penicillin G resistant Streptococcus pneumoniae]
P Longuet1, E Vallée, M Michel
1Service des Maladies infectieuses et tropicales, Hôpital Bichat-Claude Bernard, Paris.
Abstract:
We report two cases of penicillin G-resistant pneumococcal meningitis in adults, with clinical and bacteriological failure of amoxicillin and negative or incomplete response to third generation cephalosporins. Meningitis occurred in a man treated for myeloma and in an elderly woman under prolonged intermittent amoxicillin therapy for chronic otitis. Such situations are known as exposing to pneumococcal meningitis and to resistance of the strain involved to penicillin G. Both patients were cured by vancomycin in continuous infusion associated with rifampicin or fosfomycin. Contrary to third generation cephalosporins, which have higher minimal inhibitory concentrations, vancomycin and rifampicin are still fully active against penicillin G-resistant pneumococcal strains. Thus, vancomycin administered in continuous infusion and associated with rifampicin and fosfomycin deserves to be tried as first-line treatment of pneumococcal meningitis in patients at risk of resistance to penicillin G.
Insights
Penicillin G-resistant pneumococcal meningitis cases failed amoxicillin and cephalosporins. Vancomycin with rifampicin or fosfomycin successfully treated these resistant infections, suggesting a new first-line approach.
Area of Science:
- Infectious Diseases
- Microbiology
- Pharmacology
Background:
- Pneumococcal meningitis remains a significant public health concern.
- Emergence of penicillin G-resistant Streptococcus pneumoniae strains poses therapeutic challenges.
- Standard treatments like amoxicillin and third-generation cephalosporins may fail in resistant cases.
Observation:
- Two adult patients with penicillin G-resistant pneumococcal meningitis experienced treatment failure with amoxicillin.
- These patients also showed inadequate response to third-generation cephalosporins.
- Risk factors included myeloma treatment and chronic otitis with amoxicillin therapy.
Findings:
- Vancomycin administered via continuous infusion, combined with either rifampicin or fosfomycin, achieved clinical and bacteriological cure in both patients.
- Vancomycin and rifampicin demonstrated sustained activity against penicillin G-resistant pneumococcal strains, unlike third-generation cephalosporins with higher minimum inhibitory concentrations.
- This combination therapy proved effective where conventional treatments failed.
Implications:
- Vancomycin in continuous infusion, along with rifampicin or fosfomycin, is a promising first-line treatment option for pneumococcal meningitis in patients at risk of penicillin G resistance.
- This approach may improve outcomes for patients infected with highly resistant pneumococcal strains.
- Further clinical trials are warranted to validate this therapeutic strategy.