Evaluation of a triple-drug combination for treatment of experimental multidrug-resistant pneumococcal meningitis

Lee, Hyuck; Song, Jae–Hoon; Kim, Shin‐Woo; Oh, Won Sup; Jung, Sook In; Kiem, Sungmin; Peck, Kyong Ran; Lee, Nam Yong

doi:10.1016/j.ijantimicag.2003.07.015

Cited by 15 publications

(10 citation statements)

References 10 publications

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“…Two other experimental rabbit studies of penicillin-and cephalosporin-resistant pneumococcal meningitis compared the use of ceftriaxone and rifampin combination therapy to regimens that included vancomycin, and revealed that the addition of rifampin to ceftriaxone was comparable to the combination of ceftriaxone and vancomycin. One showed equal efficacy [33] and the other showed superior efficacy [34]; in the latter study, the three-drug combination (vancomycin, ceftriaxone, and rifampin) had similar efficacy to the combination of ceftriaxone and rifampin.…”

Section: Rifampinmentioning

confidence: 79%

Treatment of Drug-resistant Pneumococcal Meningitis

Hameed

Tunkel

2010

Curr Infect Dis Rep

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The approach to therapy in patients with pneumococcal meningitis has changed considerably over the past 20 years. Given the emergence of pneumococcal strains that are intermediately susceptible or highly resistant to penicillin, penicillin is not recommended as empiric therapy for presumed pneumococcal meningitis; the combination of vancomycin and a third-generation cephalosporin (either cefotaxime or ceftriaxone) should be used, pending isolation of the organism and in vitro susceptibility testing. For patients with pneumococcal meningitis caused by highly penicillin- or cephalosporin-resistant strains, the addition of rifampin can be considered if the organism is susceptible in vitro, the expected clinical or bacteriologic response is delayed, or the pneumococcal isolate has a cefotaxime or ceftriaxone minimal inhibitory concentration greater than 4 μg/mL. Meropenem is not a good option for monotherapy of highly penicillin- or cephalosporin-resistant strains, but use of a fluoroquinolone with in vitro activity against Streptococcus pneumoniae (specifically moxifloxacin) is an option in patients failing standard therapy; if used, however, it should be combined with a third-generation cephalosporin or vancomycin. Newer glycopeptides, daptomycin, and linezolid require further study to determine their efficacy in patients with pneumococcal meningitis.

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Section: Rifampinmentioning

confidence: 79%

Treatment of Drug-resistant Pneumococcal Meningitis

Hameed

Tunkel

2010

Curr Infect Dis Rep

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“…Reduced susceptibility to penicillin and third-generation cephalosporins of Streptococcus pneumoniae is a growing problem in China although resistance rates vary considerably between countries [2]. Some experts advise that when Streptococcus pneumoniae has been identified and susceptibility testing is pending or not available, empiric treatment should include vancomycin or rifampicin, although there is uncertainty regarding the benefit of adding vancomycin or rifampicin to a third-generation cephalosporin in Streptococcus pneumoniae meningitis patients [39][40][41]. Erythromycin, tetracycline, clindamycin, penicillin and trimethoprim/sulfamethoxazole were the least effective antibiotics against Streptococcus pneumoniae.…”

Section: Discussionmentioning

confidence: 99%

“…Another study noted that the extent of CSF abnormalities depends on the causative microorganism and can assess the cause of suspected meningitis [40]. Our study tried to assess the utility of CSF WBC, protein and glucose concentration in assessing the cause of suspected meningitis.…”

Section: Discussionmentioning

confidence: 99%

The microbiology and clinical characteristics of bacterial and fungal meningitis in a Chinese hospital

Chen¹,

Hu²,

Liu³

2017

Arch Med Sci Civil Dis

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A b s t r a c t Introduction:The aim was to investigate the distribution, antibiotic resistance, initial clinical and laboratory characteristics of pathogens isolated from the cerebrospinal fluid samples (CSF). Material and methods: The CSF were subjected for identification. The minimum inhibitory concentrations (MICs) of antimicrobial agents were tested. The initial clinical and laboratory characteristics were collected. Results: The rate of positive yield of pathogen meningitis in our study was 8.16% . Among the 1994 non-repetitive pathogens, Gram-positive pathogen was the most common (71.71%), followed by Gram-negative pathogen (20.36%), fungal (6.62%) and Mycobacterium tuberculosis (1.30%). Coagulase-negative staphylococci (CNS) was the most common Gram-positive pathogen and Acinetobacter baumannii (Ab) was the most common Gram-negative pathogen. As to fungal pathogen, Cryptococcus neoformans (CN) was the most common. The main CNS showed higher antimicrobial resistant rate for Penicillin G, oxacillin, clindamycin and erythromycin. Acinetobacter baumannii resistant to the most tested antibiotics and only showed considerable rate of resistance to cefoperazone/sulbactam, tigecycline and amikacin. All CN were susceptible to 5-fluorocytosine and only 3.6% CN were resistance to fluconazole. Long days of hospital stay, fever and meningeal irritation signs were common symptoms in the bacterial and fungal meningitis. Head injury, disturbance of consciousness, the pupil size of both eyes was not equal, pupillary reaction to light was slow or absent were more common in the Ab meningitis. The CSF protein concentration and white blood cells count as well as glucose concentration can be used in guiding initial treatment and further microbiological investigation. Conclusions: The main pathogens showed higher antimicrobial resistant rate and the selection of empiric antibiotics should take into consideration local epidemiology, antibiotic resistance patterns and the suspected causative microorganism.

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“…There was a strong positive correlation between serum and CSF levels of vancomycin. Open circles, clinical studies that used dexamethasone [9], including our study (arrow); open squares, experimental studies with dexamethasone [21,23,27]; solid circles, clinical studies in which treatment did not include use of dexamethasone [25,26]; solid squares, experimental studies without dexamethasone [23,27].…”

Section: Discussionmentioning

confidence: 99%