OCCURRENCE OF STREPTOCOCCUS PNEUMONIAE MENINGITIS DURING VANCOMYCIN AND CEFOTAXIME THERAPY OF SEPTICEMIA IN A PATIENT WITH SICKLE CELL DISEASE

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Abstract
Strains of Streptococcus pneumoniae resistant to penicillin and the extended spectrum cephalosporins ceftriaxone and cefotaxime are becoming increasingly prevalent.1–4 These resistant strains pose a particular risk for children with sickle cell disease whose immune defenses are compromised despite daily penicillin prophylaxis and pneumococcal vaccine. The child reported here had persistently positive blood cultures for 48 hours during intravenous cefotaxime and gentamicin therapy and meningitis developed 2½ days after intravenous vancomycin was added. This patient illustrates the fine line that exists between ineffective and effective doses of antimicrobials for sepsis and meningitis caused by multiply resistant S. pneumoniae, particularly in the immunocompromised host.