Bactericidal activity against cephalosporin-resistant Streptococcus pneumoniae in cerebrospinal fluid of children with acute bacterial meningitis

Antimicrob Agents Chemother. 1995 Sep;39(9):1988-92. doi: 10.1128/AAC.39.9.1988.

Abstract

There are reports of failure of extended-spectrum cephalosporin treatment in pneumococcal meningitis. On the basis of in vitro and animal experimental studies, the addition of vancomycin or rifampin to an extended-spectrum cephalosporin has been recommended for empiric treatment of these patients. Cerebrospinal fluid (CSF) was taken from 31 children with bacterial meningitis randomized to receive ceftriaxone alone (n = 11), ceftriaxone plus rifampin (n = 10), or ceftriaxone plus vancomycin (n = 10). The CSF from children receiving ceftriaxone alone was unable to kill intermediately ceftriaxone-resistant or fully resistant strains when the concentration of ceftriaxone in the CSF was less than 5 micrograms/ml. At higher concentrations bactericidal activity was present. We have shown that vancomycin penetrates reliably into the CSF of children with acute meningitis, which is in contrast to previous studies with adults. The addition of vancomycin or rifampin to ceftriaxone resulted in significantly enhanced CSF bactericidal activity compared with that of ceftriaxone alone against these resistant strains. Our data suggest that the addition of rifampin or vancomycin to ceftriaxone may be useful for the treatment of cephalosporin-resistant pneumococcal meningitis.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Anti-Bacterial Agents / cerebrospinal fluid*
  • Ceftriaxone / cerebrospinal fluid
  • Cephalosporin Resistance*
  • Child, Preschool
  • Dexamethasone / therapeutic use
  • Humans
  • Infant
  • Meningitis, Pneumococcal / cerebrospinal fluid*
  • Rifampin / cerebrospinal fluid
  • Serum Bactericidal Test
  • Streptococcus pneumoniae / drug effects*
  • Vancomycin / cerebrospinal fluid

Substances

  • Anti-Bacterial Agents
  • Vancomycin
  • Ceftriaxone
  • Dexamethasone
  • Rifampin