Compared with beta-lactam antibiotics,rifampin releases smaller quantities
of proinflammatory cell wall products from Streptococcus pneumoniae in vitr
o. Mice infected intracerebrally with S. pneumoniae were treated subcutaneo
usly with 2-mg doses of rifampin or ceftriaxone (n = 43 each) every 12 h fo
r 3 days and then observed for another 3 days. Rifampin reduced overall mor
tality from 49% to 26% (P = .04). Kaplan-Meyer analysis revealed a substant
ial reduction of mortality during the first 24 h in mice receiving rifampin
(difference in survival time: P = .007). Eight h after receiving a single
2-mg dose of rifampin or ceftriaxone, rifampin-treated mice had lower serum
and cerebrospinal fluid concentrations of lipoteichoic and teichoic acids
than did ceftriaxone-treated mice (median serum level: <0.5 vs, 27.0 ng/mL,
P = .02; median cerebrospinal fluid level of pooled specimens: 97.5 vs. 20
6.0 ng/mL), Thus, the use of rifampin appears promising for reducing the re
lease of proinflammatory bacterial components and decreasing early mortalit
y in bacterial meningitis.