No isolate was resistant to vancomycin. Cefotaxime-sensitivity of Streptococcus pneumoniae isolated from blood cultures and CSFs Figure 5. Cefotaxime-sensitivity of Streptococcus pneumoniae isolated from sites other than blood cultures and CSFs Figure 6. Rifampicin is rarely used in the community, so it is not surprising that resistance to this agent has been minimal. In the case of meningitis, treatment failures are well described, even with isolates of intermediate resistance.
Smaller percentages are also resistant to cefotaxime.
In this situation, it may be reasonable to add vancomycin to the empiric treatment. If PRSP is isolated from a patient with meningitis, modification of the drug regimen is not defined and specialist advice should be sought. A recent Australian paper reported that children with invasive penicillin-resistant pneumococcal infections, particularly meningitis, required longer hospitalisation, and it took longer for their fever to abate. The treatment of the much more common respiratory infections is more difficult. However, newer quinolones may be useful.