STREPTOCOCCUS-PNEUMONIAE MENINGITIS IN CH ILDREN - SHOULD INITIAL ANTIBIOTIC-TREATMENT BE CHANGED

Background.- Since a significant proportion of Streptococcus pneumonia e strains is now resistant to penicillin and sometimes to third-genera tion cephalosporin, it is necessary to reevaluate the initial therapy of bacterial meningitis proposed before identification of the organism and its susceptibility pattern.Population.- From I January 1992 to 31 March 1994, nine children with acute S pneumoniae meningitis were tre ated with ceftriaxone plus aminoglycoside as conventional initial ther apy. Eight children were less than 1 year-old (five from 3 to 6 months ). Five S pneumoniae strains were penicillin-resistant; four had a cef triaxone minimal inhibitor, concentration (MIC) of 0.047 to 0.094 mg/L and one of 1.5 mg/L. Ceftriaxone was given intravenously at doses of 50 mg/kg twice a day to patients less than 12 months old and 100 mg/kg once a day to patients older than 12 months. Intravenous amikacin (7. 5 mg/kg twice daily) or netilmicin (3 mg/kg twice daily) were administ red in combination. Dexomethasone was given to all children as adjunct ive therapy. Follow-up lumbar puncture was performed after 24 to 36 ho urs of treatment. Results.- For each of the nine patients, cerebrospin al fluid was sterile with normal glucose level. After 2 or 4 days, ini tial therapy had been modified according to antibiogram and MIC. Monot herapy with ceftriaxone was continued in five children. Rifampicin was associated with initial bitherapy in one case. In two other patients, initial empiric therapy was stopped and changed to chloramphenicol. C onclusion.- No case of bacteriological failure was noted in our patien ts but evolution of epidemiology and emergence of decreased penicillin sensibility in S pneumoniae strains (55% in our study) suggests that a third antibiotic (vancocin or rifampicin) should be associated with the standard first-line drug when S pneumoniae is suspected.