Longuet P, Vallée E, Michel M, Perronne C, Janvier M, Leport C, Vildé J L
Service des Maladies infectieuses et tropicales, Hôpital Bichat-Claude Bernard, Paris.
Presse Med. 1993 Nov 20;22(36):1818-9.
We report two cases of penicillin G-resistant pneumococcal meningitis in adults, with clinical and bacteriological failure of amoxicillin and negative or incomplete response to third generation cephalosporins. Meningitis occurred in a man treated for myeloma and in an elderly woman under prolonged intermittent amoxicillin therapy for chronic otitis. Such situations are known as exposing to pneumococcal meningitis and to resistance of the strain involved to penicillin G. Both patients were cured by vancomycin in continuous infusion associated with rifampicin or fosfomycin. Contrary to third generation cephalosporins, which have higher minimal inhibitory concentrations, vancomycin and rifampicin are still fully active against penicillin G-resistant pneumococcal strains. Thus, vancomycin administered in continuous infusion and associated with rifampicin and fosfomycin deserves to be tried as first-line treatment of pneumococcal meningitis in patients at risk of resistance to penicillin G.
我们报告了两例成人耐青霉素G肺炎球菌性脑膜炎病例，阿莫西林治疗出现临床和细菌学失败，对第三代头孢菌素反应阴性或不完全。脑膜炎分别发生在一名接受骨髓瘤治疗的男性和一名因慢性中耳炎长期间歇性接受阿莫西林治疗的老年女性身上。这种情况被认为易患肺炎球菌性脑膜炎且所涉及菌株对青霉素G耐药。两名患者均通过持续输注万古霉素联合利福平或磷霉素治愈。与具有较高最低抑菌浓度的第三代头孢菌素不同，万古霉素和利福平对耐青霉素G肺炎球菌菌株仍具有完全活性。因此，持续输注万古霉素联合利福平及磷霉素值得作为对青霉素G耐药风险患者肺炎球菌性脑膜炎的一线治疗方法尝试。
