Meningitis Due to Ceftriaxone-ResistantStreptococcus pneumoniae

Abstract

Penicillin-resistant strains of Streptococcus pneumoniae are found in many countries and are spreading, especially among children in day-care centers. Many authorities now recommend treating suspected cases of pneumococcal meningitis with ceftriaxone (or cefotaxime) and adding vancomycin, with or without rifampin, in communities where pneumococci highly resistant to penicillin are prevalent,^1,2 because many such strains of pneumococci are not susceptible to ceftriaxone.³ In Providence, Rhode Island, only 2.3 percent of blood isolates of S. pneumoniae obtained at two hospitals in 1990 and 1991 had intermediate-level resistance to penicillin, and none were highly resistant.⁴ Hence, we presumed the prevalence of resistant strains in our area to be low.