Fosfomycin in combination with ceftriaxone or vancomycin appeared to be effective for the treatment of experimental cephalosporin-resistant pneumococcal meningitis. These combinations are possible alternatives in cases of allergy or intolerance to first-line drugs or in rare meningitis caused by highly cephalosporin-resistant pneumococci.

In the in vivo setting we were unable to demonstrate the synergism between glycopeptides and beta-lactams observed in vitro; nor did combinations show antagonism against any of the strains. Though the usefulness of these combinations cannot be totally ruled out in highly specific clinical conditions, it seems unlikely that they will provide a serious therapeutic alternative in most hGISA and GISA infections in the coming years.

Ceftriaxone plus vancomycin, and vancomycin plus rifampicin appeared to be effective in the therapy of experimental pneumococcal meningitis caused by highly cephalosporin-resistant strains such as ATCC 51916. Our results provide an experimental basis for using these combinations as empirical therapy for pneumococcal meningitis, regardless of the degree of cephalosporin resistance of the causative strain.

No abstract