From the Guidelines
The empirical antibiotic of choice for Streptococcus meningitis is a third-generation cephalosporin, such as ceftriaxone (2g IV every 12 hours), due to its broad-spectrum activity and effectiveness against Streptococcus species. This recommendation is based on the most recent and highest quality study available, which suggests that ceftriaxone is a suitable option for the treatment of pneumococcal meningitis, including cases where the pneumococcus is penicillin sensitive or resistant but cephalosporin sensitive 1. For patients with penicillin allergy, vancomycin (15-20 mg/kg IV every 8-12 hours) can be used as an alternative. Treatment duration is generally 10-14 days, depending on clinical response. In cases where empiric therapy is started before the pathogen is identified, combination therapy with vancomycin plus a third-generation cephalosporin is often recommended until culture results are available.
Some key points to consider when treating Streptococcus meningitis include:
- The use of adjunctive dexamethasone (0.15 mg/kg IV every 6 hours for 2-4 days) to reduce inflammation and improve outcomes, especially if started before or with the first dose of antibiotics 1.
- The importance of achieving a trough vancomycin level of 15-20 mg/L when using vancomycin, as its penetration into adult CSF may be limited, especially if dexamethasone has also been given 1.
- The need to consider the patient's recent travel history and potential exposure to areas with high prevalence of multidrug-resistant organisms, such as extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae, when selecting empirical antibiotic therapy 1.
Overall, the choice of empirical antibiotic therapy for Streptococcus meningitis should be guided by the most recent and highest quality evidence available, with consideration of the patient's individual risk factors and clinical presentation.
From the FDA Drug Label
MENINGITIS caused by Haemophilus influenzae, Neisseria meningitidis or Streptococcus pneumoniae Ceftriaxone for Injection, USP has also been used successfully in a limited number of cases of meningitis and shunt infection caused by Staphylococcus epidermidis1 and Escherichia coli.
The empirical antibiotic of choice for Streptococcal meningitis is Ceftriaxone, specifically for Streptococcus pneumoniae 2.
From the Research
Empirical Antibiotic of Choice for Streptococcus Meningitis
The empirical antibiotic of choice for Streptococcus meningitis is a topic of significant interest due to the varying resistance patterns of Streptococcus pneumoniae.
- The choice of empirical antibiotic therapy is crucial for the effective treatment of Streptococcus meningitis, considering the potential for resistance to commonly used antibiotics like penicillin and cephalosporins 3, 4, 5.
- Studies have shown that vancomycin, in combination with a third-generation cephalosporin such as ceftriaxone, may be an effective empirical therapy for pneumococcal meningitis, including cases caused by cephalosporin-resistant strains 3, 4, 5.
- The combination of vancomycin and ceftriaxone has been found to be synergistic against some strains of Streptococcus pneumoniae, suggesting its potential as an initial empiric therapy until susceptibility results are available 3.
- Other combinations, such as vancomycin plus rifampicin, have also shown promise in experimental models of meningitis caused by highly cephalosporin-resistant Streptococcus pneumoniae 4.
- The use of vancomycin or rifampicin in addition to ceftriaxone has been recommended based on in vitro and animal experimental studies for the empiric treatment of pneumococcal meningitis, especially in cases where cephalosporin resistance is suspected 5.
- However, it's also important to consider the resistance rates of Streptococcus pneumoniae to different antibiotics, as well as the serotypes involved, when selecting an empirical antibiotic regimen 6.
- In vitro killing activities of antibiotics at clinically achievable concentrations in cerebrospinal fluid against penicillin-resistant Streptococcus pneumoniae have shown that imipenem can be effective, and combinations with other antibiotics like gentamicin may enhance killing activity 7.