MANAGEMENT OF MENINGITIS CAUSED BY PENICILLIN-RESISTANT STREPTOCOCCUS-PNEUMONIAE

Since the isolation of the first penicillin-resistant Streptococcus pn eumoniae strain in 1967 (23), there have been many reports of treatmen t failure in patients with pneumococcal infections caused by strains r esistant to penicillin and other antimicrobial agents such as chloramp henicol, macrolides, trimethoprim-sulfamethoxazole, and the cephalospo rins. As a result, the selection of antimicrobial agents for the treat ment of infections caused by these organisms has become increasingly difficult. In particular, the emergence of pneumococci resistant to br oad-spectrum cephalosporins has limited the choices of antibiotics for the treatment of pneumococcal meningitis. This minireview focuses on the specific problems encountered in managing patients with penicillin - and cephalosporin-resistant pneumococcal meningitis and discusses so me therapeutic alternatives that have recently been explored.