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The challenge of penicillin-resistant Streptococcus pneumoniae meningitis: current antibiotic therapy in the 1990s
1Division of Infectious Diseases, Children's Hospital, San Diego, California 92123, USA.
Abstract:
Bacterial meningitis caused by Streptococcus pneumoniae is an important cause of neurological morbidity and mortality in both children and adults. With increasing antibiotic resistance in pneumococci and documented microbiological failure in treatment of pneumococcal meningitis with cefotaxime and ceftriaxone, the need for alternative antibiotic therapy is critical. Of the currently available options, vancomycin has shown the most promise, particularly when used in combination with ceftriaxone or cefotaxime. Rifampin, also used in combination with either ceftriaxone or cefotaxime, has demonstrated encouraging preliminary results against antibiotic-resistant pneumococci as well. Chloramphenicol has unexpectedly yielded discouraging clinical results in children with infection caused by penicillin-resistant strains. Of the investigational antibiotics currently in clinical trials for the treatment of meningitis, meropenem, a carbapenem-class antibiotic, has demonstrated increased activity against penicillin-resistant pneumococci compared with that of other beta-lactam antibiotics, while having a safety profile similar to that of the cephalosporins.
Insights
Antibiotic resistance in Streptococcus pneumoniae meningitis necessitates new treatments. Vancomycin and rifampin show promise, while meropenem offers an alternative with a favorable safety profile for resistant strains.
Area of Science:
- Infectious Diseases
- Microbiology
- Neurology
Background:
- Bacterial meningitis, particularly from Streptococcus pneumoniae, causes significant neurological disability and death.
- Increasing antibiotic resistance in pneumococci challenges current treatment protocols.
- Microbiological treatment failures with cefotaxime and ceftriaxone highlight the urgent need for alternative therapies.
Purpose of the Study:
- To review current and investigational antibiotic options for treating Streptococcus pneumoniae meningitis.
- To assess the efficacy and safety of alternative antibiotics against resistant pneumococcal strains.
Main Methods:
- Review of existing literature on antibiotic treatments for bacterial meningitis.
- Analysis of clinical trial data for investigational antibiotics.
- Comparison of antibiotic activity and safety profiles against Streptococcus pneumoniae.
Main Results:
- Vancomycin, often in combination with ceftriaxone or cefotaxime, shows promise.
- Rifampin combined with cephalosporins demonstrates encouraging preliminary results against resistant strains.
- Chloramphenicol yielded poor clinical outcomes in children with penicillin-resistant infections.
- Meropenem exhibits enhanced activity against penicillin-resistant pneumococci with a safety profile comparable to cephalosporins.
Conclusions:
- Effective treatment of antibiotic-resistant Streptococcus pneumoniae meningitis requires exploring alternative antibiotic strategies.
- Vancomycin, rifampin, and meropenem represent promising therapeutic options for resistant pneumococcal meningitis.