Treatment failure with use of a third-generation cephalosporin for penicillin-resistant pneumococcal meningitis: case report and review

Clin Infect Dis. 1994 Feb;18(2):188-93. doi: 10.1093/clinids/18.2.188.


Recent reports have documented the increasing number of pneumococcal isolates that are relatively or completely resistant to penicillin and other antibiotics. This report documents a case in which third-generation cephalosporin failed in the treatment of pneumococcal meningitis and reviews the clinical and microbiological features of the seven similar cases reported to date. In all eight cases, the pneumococci were penicillin resistant. Taken together, these cases suggest that (1) children with intermediately penicillin-resistant pneumococcal meningitis (MIC, 0.1-1.0 micrograms/mL) who are treated with cefotaxime or ceftriaxone should be observed carefully for treatment failure and (2) children with highly penicillin-resistant pneumococcal meningitis (MIC, > or = 2.0 micrograms/mL) are best treated with vancomycin and rifampin until the MICs of cefotaxime and ceftriaxone for the pneumococcus are known.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Cefotaxime / adverse effects*
  • Ceftriaxone / adverse effects*
  • Drug Resistance, Microbial
  • Humans
  • Infant
  • Male
  • Meningitis, Pneumococcal / drug therapy*
  • Meningitis, Pneumococcal / microbiology
  • Microbial Sensitivity Tests
  • Penicillin Resistance
  • Rifampin / therapeutic use
  • Streptococcus pneumoniae / drug effects
  • Vancomycin / therapeutic use


  • Vancomycin
  • Ceftriaxone
  • Cefotaxime
  • Rifampin