What is the recommended treatment for Streptococcus pneumoniae (S. pneumoniae) meningitis?

From the Guidelines

The recommended treatment for Streptococcus pneumoniae meningitis is a combination of intravenous antibiotics, typically starting with empiric therapy of vancomycin plus a third-generation cephalosporin (ceftriaxone or cefotaxime) until susceptibility results are available. For adults, vancomycin should be dosed at 15-20 mg/kg every 8-12 hours (targeting trough levels of 15-20 μg/mL), along with ceftriaxone 2g every 12 hours or cefotaxime 2g every 4-6 hours, as suggested by the UK Joint Specialist Societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults 1.

Key Considerations

• The choice of antibiotic depends on the susceptibility of the organism, with penicillin-sensitive strains being treated with benzylpenicillin 2.4 g every 4 hours, and penicillin-resistant strains requiring cefotaxime or ceftriaxone, with or without vancomycin 1.
• Treatment duration is typically 10-14 days for uncomplicated cases, but may need to be extended in cases of slow response or complicated disease 1.
• Adjunctive dexamethasone (0.15 mg/kg every 6 hours for 2-4 days) should be administered before or with the first antibiotic dose to reduce inflammation and improve outcomes, particularly in adults 1.
• Supportive care, including management of increased intracranial pressure, seizures, and maintenance of adequate cerebral perfusion, is also essential.

Antibiotic Regimens

• For penicillin-sensitive Streptococcus pneumoniae, benzylpenicillin 2.4 g every 4 hours or cefotaxime 2g every 6 hours can be used 1.
• For penicillin-resistant Streptococcus pneumoniae, cefotaxime 2g every 6 hours or ceftriaxone 2g every 12 hours, with or without vancomycin, can be used 1.
• Vancomycin should be used with caution, as its penetration into adult CSF may be limited, especially if dexamethasone is also being used, and a trough level of 15-20 mg/L should be aimed for 1.

Conclusion is not allowed, so the answer just ends here.

From the FDA Drug Label

Ceftriaxone for Injection is indicated for the treatment of the following infections when caused by susceptible organisms: ... MENINGITIS Caused by Haemophilus influenzae, Neisseria meningitidis or Streptococcus pneumoniae The recommended treatment for Streptococcus pneumoniae (S. pneumoniae) meningitis is Ceftriaxone for Injection 2.

• The drug label indicates that Ceftriaxone for Injection is effective against Streptococcus pneumoniae in the treatment of meningitis.
• It is essential to note that therapy may be instituted prior to obtaining results of susceptibility testing, and local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.

From the Research

Treatment Overview

The recommended treatment for Streptococcus pneumoniae (S. pneumoniae) meningitis involves the use of antibiotics. The choice of antibiotic depends on the susceptibility of the S. pneumoniae strain to various antibiotics.

Antibiotic Options

• The combination of vancomycin and a third-generation cephalosporin (either cefotaxime or ceftriaxone) is recommended as empiric therapy for presumed pneumococcal meningitis, pending isolation of the organism and in vitro susceptibility testing 3.
• For patients with pneumococcal meningitis caused by highly penicillin- or cephalosporin-resistant strains, the addition of rifampin can be considered if the organism is susceptible in vitro 3.
• High doses of cefotaxime (300 mg/kg of body weight per day; maximum dose, 24 g/day) have been used to treat adult meningitis due to S. pneumoniae with decreased susceptibilities to broad-spectrum cephalosporins 4.
• Ceftriaxone has been shown to be effective in the treatment of acute bacterial meningitis, including S. pneumoniae meningitis, and can be used as an alternative to ampicillin plus chloramphenicol 5.

Dosing Regimens

• The recommended empiric ceftriaxone dosing regimen for acute bacterial meningitis in adults is 2 g every 12 h 6.
• However, a study found that a ceftriaxone total daily dose of 2 g may be associated with similar outcomes to a 4 g total daily dose, provided that the causative organism is highly susceptible to ceftriaxone 6.

Resistance and Susceptibility

• The emergence of pneumococcal strains that are intermediately susceptible or highly resistant to penicillin has led to a change in the approach to therapy for pneumococcal meningitis 3.
• The use of vancomycin and a third-generation cephalosporin is recommended to ensure coverage of resistant strains 3.
• Susceptibility testing is essential to guide antibiotic therapy and ensure effective treatment of S. pneumoniae meningitis 3, 7, 6.