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• W1987173731 abstract "F W Goldstein and J Garau's July 26 commentary1Goldstein FW Garau J 30 years of penicillin-resistant S pneumoniae: myth or reality?.Lancet. 1997; 350: 233-234Summary Full Text Full Text PDF PubMed Scopus (47) Google Scholar asks whether penicillin-resistant Streptococcus pneumoniae is a myth or reality. We believe that the answer depends upon the site of infection. The statement that β-lactam antibiotics may be successful in penicillin-resistant pneumococcal infections is reasonable, but in our view oversimplifies the management of meningitis. They cite one case report that suggested an increased dose of penicillin cured a patient with pneumococcal meningitis.2Naraqi S Kirkpatrick GP Kabins S Relapsing pneumococcal meningitis: isolation of an organism with decreased susceptibility to penicillin.J Pediatr. 1974; 85: 671-673Summary Full Text PDF PubMed Scopus (128) Google Scholar This patient relapsed and yielded a positive S pneumoniae culture from his cerebrospinal fluid (CSF) after 8 days of treatment with penicillin (500000 U/kg daily), a dose which is greater than that recommended at present. He was subsequently treated with 1 million U/kg daily, given every 2 h; therapy was discontinued 37 days after admission. The CSF penicillin concentration at this very high dose was O.l6 μg/mL, less than the penicillin minimum inhibitory concentration of the pneumococcal isolate (0·25 μg/mL). Since this case was reported, published research shows the failure of high-dose penicillin in pneumococcal meningitis, particularly in the treatment of pneumococcal meningitis with 400000 U/kg daily and chloramphenicol in penicillin-resistant strains.3Friedland IR Klugman KP Failure of chloramphenicol therapy in penicillin- resistant pneumococcal meningitis.Lancet. 1992; 339: 405-408Summary PubMed Scopus (162) Google Scholar Although amoxycillin may be one dilution more active than penicillin against some penicillin-resistant strains,4Spangler SA Jacobs MR Appelbaum PC In vitro susceptibilities of 185 penicillin- susceptible and -resistant pneumococci to WY-49605 (SUN/SY5555), a new oral penem, compared with those to penicillin G, amoxycillin, amoxycillin-clavulanate, cefixime, cefaclor, cefpodoxime, cefuroxime and cefdinir.Antimicrob Agents Chemother. 1994; 38: 2902-2904Crossref PubMed Scopus (53) Google Scholar the mean CSF concentration of amoxycillin is 2 mg/L5Lacut JY Humbert Aubertin J Quentin C Leroy A Treatment of purulent meningitis in adults with injectable amoxycillin: clinical and pharmacokinetic results.Curr Ther Res. 1981; 29: 36-46Google Scholar, which is insufficient to suggest that therapy will be successful for the management of fully penicillin-resistant strains. We concur that the available evidence suggests that first-line μ-lactams are effective for the management of pneumococcal pneumonia at the current levels of resistance encountered, and that the recommended dose for the oral management of otitis media with amoxycillin should be increased. We applaud Goldstien and Garau's message that clinicians should not infer clinical failure as a necessary consequence of the laboratory documentation of resistance in the pneumococcus, but would caution against the interpretation that penicillin-resistant pneumococcal meningitis may be safely treated with penicillin or amoxycillin, even in high dose." @default.
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• W1987173731 date "1997-10-01" @default.
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• W1987173731 title "Penicillin-resistant pneumococcal meningitis" @default.
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• W1987173731 doi "https://doi.org/10.1016/s0140-6736(05)63822-6" @default.
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