Therapy of penicillin- and cephalosporin-resistant pneumococcal infections.

Streptococcus pneumoniae has recently developed resistance to almost every agent that has been used for therapy, including the extended-spectrum cephalosporins. The empiric therapy of penicillin-resistant pneumococcal meningitis should include cefotaximine or ceftriaxone plus vancomycin pending cephalosporin susceptibility results. Intermediate penicillin-resistant pneumococcal infections outside the central nervous system will usually respond to high dose intravenous beta-lactam antibiotic therapy. Highly penicillin-resistant pneumococcal infections may not respond to penicillin therapy, in which case therapy with vancomycin, imipenem or a macrolide (if susceptible) can be considered. Pneumococcal resistance to commonly used oral agents varies geographically and the efficacy of a particular agent can only be assured once the infecting strain is known to be susceptible. It is imperative to determine the susceptibility of every pneumococcal isolate to the agent(s) being used for therapy, particularly in cases of meningitis and to document rapid sterilization of infected body sites or fluids.