ANTIBIOTIC-RESISTANCE IN NEISSERIA-MENINGITIDIS

Penicillin has long been recognized as the antibiotic of choice for tr eatment of meningococcal infections, but clinicians have recently beco me concerned about the susceptibility of meningococci to penicillin an d other antibiotics used in the management of meningococcal disease. S trains relatively resistant to penicillin (minimum inhibitory concentr ations ranging from 0.1 mg/L to 1.28 mg/L) have been reported from a l arge number of countries, although the frequency with which such isola tes are found varies widely. The mechanism of relative resistance to p enicillin involves, at least in part, the production of altered forms of one of the penicillin-binding proteins. Although treatment with pen icillin is still effective against these relatively resistant strains, there is evidence that low-dose treatment regimens can fail. beta-lac tamase production in meningococci is extremely rare but has been repor ted, and this finding is of great concern. Resistance to sulfonamides and rifampin is of particular concern in regard to the management of c ontacts of patients with meningococcal disease.