Advertisement

Characteristics and antibiotic therapy of adult meningitis due to penicillin-resistant pneumococci

  • Pedro F. Viladrich
    Correspondence
    Requests for reprints should be addressed to Dr. Pedro F. Viladrich, Infectious Disease Unit, Department of Medicine, Hospital de Bellvitge “Princeps d'Espanya,” 08907 L'Hospitalet, Barcelona, Spain.
    Affiliations
    Department of Medicine, Infectious Disease Unit, and the Department of Microbiology, Bellvitge “Princeps d'Espanya” Hospital, and the University of Barcelona, Barcelona, Spain
    Search for articles by this author
  • Francisco Gudiol
    Affiliations
    Department of Medicine, Infectious Disease Unit, and the Department of Microbiology, Bellvitge “Princeps d'Espanya” Hospital, and the University of Barcelona, Barcelona, Spain
    Search for articles by this author
  • Josefina Liñares
    Affiliations
    Department of Medicine, Infectious Disease Unit, and the Department of Microbiology, Bellvitge “Princeps d'Espanya” Hospital, and the University of Barcelona, Barcelona, Spain
    Search for articles by this author
  • Gabriel Rufi
    Affiliations
    Department of Medicine, Infectious Disease Unit, and the Department of Microbiology, Bellvitge “Princeps d'Espanya” Hospital, and the University of Barcelona, Barcelona, Spain
    Search for articles by this author
  • Javier Ariza
    Affiliations
    Department of Medicine, Infectious Disease Unit, and the Department of Microbiology, Bellvitge “Princeps d'Espanya” Hospital, and the University of Barcelona, Barcelona, Spain
    Search for articles by this author
  • Roman Pallares
    Affiliations
    Department of Medicine, Infectious Disease Unit, and the Department of Microbiology, Bellvitge “Princeps d'Espanya” Hospital, and the University of Barcelona, Barcelona, Spain
    Search for articles by this author
      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      Of 66 episodes of pneumococcal meningitis seen in Bellvitge Hospital, Barcelona, Spain (January 1981 to June 1987), 15 (23 percent) were due to penicillin-resistant pneumococci [minimal inhibitory concentrations (MICs) of 0.1 to 4 μg/ml]. Fifty percent of these strains were also resistant to chloramphenicol. Most were sporadic community-acquired cases. Clinical characteristics were similar in both penicillin-resistant and penicillin-sensitive cases. Those cases with MICs of greater than 1 μg/ml did not show a response to penicillin therapy. Of nine patients treated with cefotaxime (200 to 350 mg/kg per day) with penicillin G MICs of 0.1 to 4 μg/ml and cefotaxime MICs of less than or equal to 0.03 to 1 μg/ml, seven recovered, one experienced a relapse after 14 days of therapy and the infection was cured with intravenous vancomycin, and one patient died with sterile cerebrospinal fluid. Thus, adults with meningitis due to penicillin-resistant pneumococci may be adequately treated with high doses (around 300 mg/kg per day) of intravenous cefotaxime if MICs of penicillin G are less than or equal to 4 μg/ml. Cases with higher resistance may require another antibiotic such as vancomycin.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Hansman D
        • Bullen MM
        A resistant pneumococcus.
        Lancet. 1967; II: 264-265
        • Hansman D
        • Glasgow H
        • Sturt J
        • Devitt L
        • Douglas R
        Increased resistance to penicillin of pneumococci isolated from man.
        N Engl J Med. 1971; 284: 175-177
        • Naraqi S
        • Kirkpatrick GP
        • Kabins S
        Relapsing pneumococcal meningitis: isolation of an organism with decreased susceptibility to penicillin G.
        J Pediatr. 1974; 85: 671-673
        • Appelbaum PC
        • Scragg JN
        • Bowen AJ
        • Bhamjee A
        • Hallett AF
        • Cooper RC
        Streptococcus pneumoniae resistant to penicillin and chloramphenicol.
        Lancet. 1977; II: 995-997
        • Howes VJ
        • Mitchell RG
        Meningitis due to relatively penicillin-resistant pneumococcus.
        Br Med J. 1976; 1: 996
        • Paredes A
        • Taber LH
        • Yow MD
        • Clark D
        • Nathan W
        Prolonged pneumococcal meningitis due to an organism with increased resistance to penicillin.
        Pediatrics. 1976; 58: 378-381
        • Mace JW
        • Janik DS
        • Sauer RL
        • Quilligan Jr, JJ
        Penicillin-resistant pneumococcal meningitis in an immunocompromised infant.
        J Pediatr. 1977; 91: 506-507
        • Devitt L
        • Riley I
        • Hansman D
        Human infection caused by penicillin-insensitive pneumococci.
        Med J Aust. 1977; 1: 586-588
        • Iyer PV
        • Kahler JH
        • Jacobs NM
        Penicillin-resistant pneumococcal meningitis.
        Pediatrics. 1978; 61: 157-158
        • Ahronheim GA
        • Reich B
        • Marks MI
        Penicillin-insensitive pneumococci: case report and review.
        Am J Dis Child. 1979; 133: 187-191
        • Gartner JC
        • Michaels RH
        Meningitis from a pneumococcus moderately resistant to penicillin.
        JAMA. 1979; 241: 1707-1709
        • Saah AJ
        • Mallonee JP
        • Tarpay M
        • Thornsberry CT
        • Roberts MA
        • Rhoades ER
        Relative resistance to penicillin in the pneumococcus: a prevalence and case-control study.
        JAMA. 1980; 243: 1824-1827
        • Radetsky MS
        • Johansen TL
        • Lauer BA
        • et al.
        Multiply resistant pneumococcus causing meningitis: its epidemiology within a day-care centre.
        Lancet. 1981; II: 771-773
        • Wamola IA
        • Mirza NB
        • Nsanzumuhire H
        Penicillin resistant pneumococcal meningitis in Kenyatta National Hospital, Nairobl, Kenya.
        East Afr Med J. 1981; 58: 12-17
        • Ward J
        Antibiotic-resistant Streptococcus pneumoniae: clinical and epidemiologic aspects.
        Rev Infect Dis. 1981; 3: 254-266
        • Caputo GM
        • Sattler FR
        • Jacobs MR
        • Appelbaum PC
        Penicillin-resistant pneumococcus and meningitis.
        Ann Intern Med. 1983; 98: 416-417
        • Istre GR
        • Humphreys JT
        • Albrecht KD
        • Thornsberry C
        • Swenson JM
        • Hopkins RS
        Chloramphenicol and penicillin resistance in pneumococci isolated from blood and cerebrospinal fluid: a prevalence study in metropolitan Denver.
        J Clin Microbiol. 1983; 17: 472-475
        • Lapointe J-R
        • Joncas JH
        Meningitis in a Canadian infant due to pneumococcus resistant to penicillin and chloramphenicol.
        J Pediatr. 1983; 103: 580-582
        • Jackson MA
        • Shelton S
        • Nelson JD
        • McCracken Jr, GH
        Relatively penicillin-resistant pneumococcal infections in pediatric patients.
        Pediatr Infect Dis. 1984; 3: 129-132
        • Maña J
        • Gaston F
        • Lonca M
        • Soriano E
        • Garcia San Miguel J
        Meningitis por neumococo moderadamente resistente a la penicilina: presentación de dos casos y revisión de la literatura.
        Med Clin (Barc). 1985; 84: 697-699
        • Perez A
        • Leon C
        • Del Valle O
        • Caballero E
        • Leon MA
        Meningitis por neumococo resistente a la penicilina.
        Med Clin (Barc). 1985; 84: 712
        • Hieber JP
        • Nelson JD
        A pharmacologic evaluation of penicillin in children with purulent meningitis.
        N Engl J Med. 1977; 297: 410-413
        • Fernandez-Viladrich P
        • Gudiol F
        • Rufi G
        • et al.
        Meningitis bacteriana.
        in: Etiologia y origen de 482 episodios. 3rd ed. Med Clin (Barc). 86. 1986: 615-620
        • Casal J
        Antimicrobial susceptibility of Streptococcus pneumoniae: serotype distribution of penicillin-resistant strains in Spain.
        Antimicrob Agents Chemother. 1982; 22: 222-225
        • Jacobs MR
        • Mithal Y
        • Robins-Browne RM
        • Gaspar MN
        • Koornhof HJ
        Antimicrobial susceptibility testing of pneumococci: determination of Kirby-Bauer breakpoints for penicillin G, erythromycin, clindamycin, tetracycline, chloramphenicol, and rifampin.
        Antimicrob Agents Chemother. 1979; 16: 190-197
        • Washington JA
        • Sutter VL
        Dilution susceptibility test: agar and macrobroth dilution procedures.
        in: 3rd ed. Manual of clinical microbiology. American Society for Microbiology, Washington1980: 453-458
        • O'Callaghan CH
        • Morris A
        • Kirby SM
        • Shingler AH
        Novel method for detection of beta-lactamases by using a chromogenic cephalosporin substrate.
        Antimicrob Agents Chemother. 1972; 1: 283-288
        • Lecaillon JB
        • Rouan MC
        • Souppart C
        • Fevre N
        • Juge F
        Determination of cefsulodine, cefotiam, cephalexine, cefotaxime, desacetylcefotaxime, cefuroxime and cefroxadin in plasma and urine by high-performance liquid chromatography.
        J Chromatogr. 1982; 228: 257-267
        • Jolley ME
        • Stroupe SD
        • Schwenzer KS
        • et al.
        Fluorescence polarization immunoassay. III. An automated system for therapeutic drug determination.
        Clin Chem. 1981; 27: 1575-1579
        • Anhalt JP
        • Sabath LD
        • Barry AL
        Special tests: bactericidal activity, activity of antimicrobics in combination, and detection of beta-lactamase production.
        in: 3rd ed. Manual of clinical microbiology. American Society for Microbiology, Washington1980: 478-488
        • Latorre C
        • Juncosa T
        • Sanfeliu I
        Antibiotic resistance and serotypes of 100 Streptococcus pneumoniae strains isolated in a children's hospital in Barcelona, Spain.
        Antimicrob Agents Chemother. 1985; 28: 357-359
        • Pallares R
        • Gudiol F
        • Liñares J
        • et al.
        Risk factors and response to antibiotic therapy in adults with bacteremic pneumonia caused by penicillin-resistant pneumococci.
        N Engl J Med. 1987; 317: 18-22
        • Quentin C
        • Cardoso-Mendes I
        • Schue P
        • Janvier G
        • Bebear C
        Pneumocoque multirésistant aux antibiotiques: une nouvelle observation.
        Presse Med. 1985; 14: 489
        • George RH
        • Mulligan EAR
        • Roycroft CA
        • Powell AM
        Multiresistant pneumococci.
        Lancet. 1981; II: 751-752
        • Appelbaum PC
        Worldwide development of antibiotic resistance in pneumococci.
        Eur J Clin Microbiol. 1987; 6: 367-377
        • Simberkoff MS
        • Lukaszewski M
        • Cross A
        • et al.
        Antibiotic-resistant isolates of Streptococcus pneumoniae from clinical specimens: a cluster of serotype 19A organisms in Brooklyn, New York.
        J Infect Dis. 1986; 153: 78-82
        • Scheld WS
        Pathogenesis and pathophysiology of pneumococcal meningitis.
        in: Sande MA Smith AL Root RK Bacterial meningitis. Churchill Livingstone, New York1985: 37-69
        • Austrian R
        Pneumococcal infections.
        in: Braunwald E Isselbacher KJ Petersdorf RG Wilson JD Martin JB Fauci AS Harrison's principles of internal medicine. 11th ed. McGraw-Hill, New York1987: 533-537
        • Tuomanen E
        • Hengstler B
        • Rich R
        • Bray MA
        • Zak O
        • Tomasz A
        Nonsteroidal anti-inflammatory agents in the therapy for experimental pneumococcal meningitis.
        J Infect Dis. 1987; 155: 985-990
        • Jacobs MR
        • Koornhof HJ
        • Robins-Browne RM
        • et al.
        Emergence of multiply resistant pneumococci.
        N Engl J Med. 1978; 299: 735-740
        • Liñares J
        • Garau J
        • Dominguez C
        • Perez JL
        Antibiotic resistance and serotypes of Streptococcus pneumoniae from patients with community-acquired pneumococcal disease.
        Antimicrob Agents Chemother. 1983; 23: 545-547
        • Ward JI
        • Moellering RC
        Susceptibility of pneumococci to 14 beta-lactam agents: comparison of strains resistant, intermediate-resistant, and susceptible to penicillin.
        Antimicrob Agents Chemother. 1981; 20: 204-207
        • Liñares J
        • Perez JL
        • Garau J
        • Murgui L
        • Martin R
        Comparative susceptibilities of penicillin-resistant pneumococci to co-trimoxazole, vancomycin, rifampin and fourteen betalactam antibiotics.
        J Antimicrob Chemother. 1984; 13: 353-359
        • Tweardy DJ
        • Jacobs MR
        • Speck WT
        Susceptibility of penicillin-resistant pneumococci to eighteen antimicrobials: implications for treatment of meningitis.
        J Antimicrob Chemother. 1983; 12: 133-139
        • McCracken Jr, GH
        • Sakata Y
        Antimicrobial therapy of experimental meningitis caused by Streptococcus pneumoniae strains with different susceptibilities to penicillin.
        Antimicrob Agents Chemother. 1985; 27: 141-145
        • Hawley HB
        • Gump DW
        • Burlington VT
        Vancomycin therapy of bacterial meningitis.
        Am J Child. 1973; 126: 261-264
        • Ryan JL
        • Pachner A
        • Andriole VT
        • Root RK
        Enterococcal meningitis: combined vancomycin and rifampin therapy.
        Am J Med. 1980; 68: 449-451