What are the symptoms and treatment of Streptococcal (Strep) meningitis and pneumonia?

From the Guidelines

Streptococcus pneumoniae meningitis and pneumonia require prompt antibiotic treatment, and the recommended treatment is high-dose intravenous ceftriaxone (2g every 12 hours in adults) or cefotaxime (2g every 4-6 hours), typically for 10-14 days, as stated in the guidelines 1. For suspected or confirmed pneumococcal meningitis, vancomycin (15-20 mg/kg IV every 8-12 hours) should be added initially until susceptibility results are available, particularly in areas with high rates of penicillin-resistant pneumococci. Some key points to consider in the treatment of pneumococcal meningitis include:

• The use of dexamethasone (0.15 mg/kg IV every 6 hours for 2-4 days) to reduce inflammation and improve outcomes, as suggested by some studies 1.
• The importance of close monitoring for clinical improvement, respiratory status, and potential complications.
• The recommendation for pneumococcal vaccines (PCV13 and PPSV23) for prevention, especially in high-risk individuals. It is essential to note that the treatment of pneumococcal infections should be guided by the most recent and highest-quality evidence, and consultation with an infectious diseases specialist is recommended in complex cases, as stated in the guidelines 1.

From the FDA Drug Label

Meropenem for injection is indicated for the treatment of bacterial meningitis caused by Haemophilus influenzae,Neisseria meningitidis and penicillin-susceptible isolates of Streptococcus pneumoniae. Cefotaxime for Injection, USP is indicated for Central nervous system infections, e.g., meningitis and ventriculitis, caused by Neisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae, Klebsiella pneumoniae* and Escherichia coli*.

Strep meningitis pneumonia can be treated with:

• Meropenem (IV) for penicillin-susceptible isolates of Streptococcus pneumoniae 2
• Cefotaxime (IV) for Streptococcus pneumoniae 3

From the Research

Strep Meningitis Pneumonia

• Strep meningitis pneumonia is a serious infection caused by Streptococcus pneumoniae, which can be resistant to penicillin and other antibiotics 4.
• The treatment of strep meningitis pneumonia depends on the severity of the infection and the susceptibility of the bacteria to antibiotics 5, 4.
• For non-meningeal pneumococcal infections, such as pneumonia, sepsis, and acute otitis media, beta-lactam antibiotics like penicillin G, amoxicillin, and ceftriaxone are recommended 4.
• For meningitis, cefotaxime or ceftriaxone, with the addition of vancomycin until susceptibility is known, are the recommended treatments 5, 4.

Antibiotic Resistance

• The incidence of penicillin resistance in Streptococcus pneumoniae has increased significantly over the past few decades, making treatment more challenging 4, 6.
• The mechanism of beta-lactam resistance in S. pneumoniae involves genetic mutations that alter penicillin-binding protein structure, resulting in decreased affinity for beta-lactam antibiotics 4.
• Time-kill studies have shown that meropenem has comparable bactericidal activity to combinations of cefotaxime, ceftriaxone, and vancomycin against cephalosporin-resistant S. pneumoniae 7.

Treatment Outcomes

• A study found that ceftriaxone dosing regimens of 2g every 24h and 2g every 12h had similar outcomes in patients with penicillin-susceptible S. pneumoniae meningitis 8.
• The overall in-hospital mortality rate for patients with S. pneumoniae meningitis was 15.4%, and 45.7% of patients reported at least one sequela of meningitis at the last follow-up 8.