ANTIBIOTIC-THERAPY AND ACUTE OUTCOME OF MENINGITIS DUE TO STREPTOCOCCUS-PNEUMONIAE CONSIDERED INTERMEDIATELY SUSCEPTIBLE TO BROAD-SPECTRUM CEPHALOSPORINS

Children with meningitis due to Streptococcus pneumoniae isolates that are relatively or fully resistant to penicillin and have decreased su sceptibility to broad-spectrum cephalosporins (MIC, greater than or eq ual to 2.0 mu g/ml) who have failed treatment with broad-spectrum ceph alosporins have been reported. The National Committee for Clinical Lab oratory Standards has newly revised guidelines indicating that S. pneu moniae isolates associated with meningitis for which the MICs are grea ter than or equal to 0.5 mu g/ml should be considered resistant to bro ad-spectrum cephalosporins. This recommendation is not clearly based o n data related to clinical outcome and may be too conservative. We pre sent data on five children who had S. pneumoniae meningitis due to iso lates that were relatively or fully resistant to penicillin (MIC range , 0.125 to 4.0 mu g/ml) and had cefotaxime or ceftriaxone MICs of 0.50 to 2.0 mu g/ml. Their clinical courses and outcomes were comparable t o those of five children with S. pneumoniae meningitis due to strains that were relatively or fully resistant to penicillin and were inhibit ed by cefotaxime at concentrations of less than or equal to 0.25 mu g/ ml, as well as to those of 25 patients with S. pneumoniae meningitis d ue to penicillin-susceptible isolates identified during the same perio d. Children with meningitis due to S. pneumoniae with cefotaxime or ce ftriaxone MICs of less than or equal to 1.0 mu g/ml may be adequately treated with these antibiotics. Further clinical data are required bef ore solid recommendations can be made regarding cephalosporin breakpoi nts for S. pneumoniae.