Therapy of penicillin-resistant pneumococcal meningitis.

Antimicrobial therapy of pneumococcal meningitis has been altered in recent years based on changes in pneumococcal susceptibility patterns, with emergence of strains that are either relatively or highly resistant to penicillin G (minimal inhibitory concentrations of 0.1-1.0 micrograms/ml and > or = 2 micrograms/ml, respectively. In areas of the world where relatively penicillin-resistant strains of Streptococcus pneumoniae are present, the third generation cephalosporins (either cefotaxime or ceftriaxone) should be used as empiric therapy, and for highly penicillin-resistant pneumococcal strains, vancomycin (with or without rifampin) is recommended. It is imperative that susceptibility testing be performed on all cerebrospinal fluid pneumococcal isolates to guide the choice of antimicrobial therapy. Vaccination recommendations with the 23-valent pneumococcal vaccine should also be strictly enforced for use in appropriate populations that are at increased risk of pneumococcal infections.