Bactericidal activity against cephalosporin-resistant Streptococcus pneumoniae in cerebrospinal fluid of children with acute bacterial meningitis
- 1 September 1995
- journal article
- clinical trial
- Published by American Society for Microbiology in Antimicrobial Agents and Chemotherapy
- Vol. 39 (9), 1988-1992
- https://doi.org/10.1128/aac.39.9.1988
Abstract
There are reports of failure of extended-spectrum cephalosporin treatment in pneumococcal meningitis. On the basis of in vitro and animal experimental studies, the addition of vancomycin or rifampin to an extended-spectrum cephalosporin has been recommended for empiric treatment of these patients. Cerebrospinal fluid (CSF) was taken from 31 children with bacterial meningitis randomized to receive ceftriaxone alone (n = 11), ceftriaxone plus rifampin (n = 10), or ceftriaxone plus vancomycin (n = 10). The CSF from children receiving ceftriaxone alone was unable to kill intermediately ceftriaxone-resistant or fully resistant strains when the concentration of ceftriaxone in the CSF was less than 5 micrograms/ml. At higher concentrations bactericidal activity was present. We have shown that vancomycin penetrates reliably into the CSF of children with acute meningitis, which is in contrast to previous studies with adults. The addition of vancomycin or rifampin to ceftriaxone resulted in significantly enhanced CSF bactericidal activity compared with that of ceftriaxone alone against these resistant strains. Our data suggest that the addition of rifampin or vancomycin to ceftriaxone may be useful for the treatment of cephalosporin-resistant pneumococcal meningitis.Keywords
This publication has 13 references indexed in Scilit:
- In vitro killing activities of antibiotics at clinically achievable concentrations in cerebrospinal fluid against penicillin-resistant Streptococcus pneumoniae isolated from children with meningitisAntimicrobial Agents and Chemotherapy, 1994
- Management of Infections Caused by Antibiotic-Resistant Streptococcus PneumoniaeNew England Journal of Medicine, 1994
- Time-kill studies of antibiotic combinations against penicillin-resistant and -susceptible Streptococcus pneumoniaeJournal of Antimicrobial Chemotherapy, 1994
- Effect of dexamethasone on therapy of experimental penicillin- and cephalosporin-resistant pneumococcal meningitisAntimicrobial Agents and Chemotherapy, 1994
- Antibiotic therapy and acute outcome of meningitis due to Streptococcus pneumoniae considered intermediately susceptible to broad-spectrum cephalosporinsAntimicrobial Agents and Chemotherapy, 1994
- Concentrations of ceftriaxone in cerebrospinal fluid of children with meningitis receiving dexamethasone therapyAntimicrobial Agents and Chemotherapy, 1994
- Evaluation of antimicrobial regimens for treatment of experimental penicillin- and cephalosporin-resistant pneumococcal meningitisAntimicrobial Agents and Chemotherapy, 1993
- Passage of cefotaxime and ceftriaxone into cerebrospinal fluid of patients with uninflamed meningesAntimicrobial Agents and Chemotherapy, 1993
- Evaluation of vancomycin for therapy of adult pneumococcal meningitisAntimicrobial Agents and Chemotherapy, 1991
- Pharmacokinetics and cerebrospinal fluid bactericidal activity of ceftriaxone in the treatment of pediatric patients with bacterial meningitisAntimicrobial Agents and Chemotherapy, 1982