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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.
Presse Medicale (Paris, France : 1983)
|November 20, 1993
Summary
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.