ANTIMICROBIAL SUSCEPTIBILITY OF HAEMOPHILUS-INFLUENZAE, NEISSERIA-MENINGITIDIS AND STREPTOCOCCUS-PNEUMONIAE ISOLATES CAUSING MENINGITIS IN THE NETHERLANDS, 1993-1994

The increasing antimicrobial resistance among pathogens frequently iso lated from patients with bacterial meningitis formed the rationale to perform a surveillance study to determine the prevalence of resistance in The Netherlands. Haemophilus influenzae strains (n = 316) isolated from cerebrospinal fluid (CSF), 1125 meningococcal strains isolated f rom blood or CSF and 398 pneumococcal strains isolated from CSF in 199 3 and 1994 were tested by the Etest for susceptibility to commonly pre scribed antibiotics for the treatment of community-acquired meningitis . In H. influenzae strains ampicillin-resistance occurred in 7.0%, res istance to chloramphenicol in 2.2%, and resistance to both antibiotics in 0.9%. The prevalence of intermediate penicillin-resistance in meni ngococci was 3.3%. Resistance to rifampicin was rarely found (0.1%). I ntermediate penicillin-resistance in pneumococci was found in only 0.5 % of isolates. All 1839 isolates were susceptible to ceftriaxone. Base d on these results, we conclude that empirical therapy of childhood co mmunity-acquired bacterial meningitis with amoxycillin and chloramphen icol is no longer justified in children who have not been vaccinated a gainst H. influenzae type b. In vaccinated or older children and adult s, amoxycillin is a rational choice for empirical treatment of meningi tis. The prophylactic use of rifampicin in contacts of patients with m eningococcal disease is still applicable.