Skip to main content
NCBI home page
Antimicrobial Agents and Chemotherapy logoLink to Antimicrobial Agents and Chemotherapy
. 1996 Apr;40(4):895–898. doi: 10.1128/aac.40.4.895

Relationship of MICs to efficacy of cefotaxime in treatment of Streptococcus pneumoniae infections.

R F Jacobs 1, S L Kaplan 1, G E Schutze 1, A S Dajani 1, R J Leggiadro 1, C S Rim 1, S K Puri 1
PMCID: PMC163226  PMID: 8849247

Abstract

In June 1993, the National Committee for Clinical Laboratory Standards (NCCLS) recommended stringent new interpretive guidelines for antibiotics indicated for Streptococcus pneumoniae meningitis. To assess the predictive values of the recommended breakpoints, retrospective data were collected from patients who had S. pneumoniae infections and were treated with cefotaxime monotherapy. Susceptibilities based on the NCCLS interpretative categories were compared with clinical and bacteriologic outcomes. In 76 evaluable patients, the most common infections were bacteremia-septicemia (n = 49), meningitis (n = 37), and lower respiratory tract infection (n = 14). Under the NCCLS breakpoints proposed in 1993, 55 isolates would have been classed as susceptible to cefotaxime (MIC, < or = 0.25 microgram/ml), 18 would have been classed as intermediate (MIC, 0.5 to 1.0 microgram/ml), and 2 would have been classed as resistant (MIC, > or = 2 micrograms/ml). Of 75 cefotaxime-treated patients for whom cefotaxime MICs were recorded, 73 were clinically cured or improved (37 of 37 with meningitis and 36 of 38 with other infections). One case of bacteremia and one case of bone-and-joint infection were scored as therapeutic failures because initial monotherapy had to be modified because of an adverse drug reaction. Excluding these patients, there were 18 patients infected with S. pneumoniae that would have been classed as not fully susceptible (i.e., MICs > or = 0.5 microgram/ml); all of these patients were cured or improved. The results of this analysis demonstrate that successful treatment with cefotaxime did not correlate well with the guidelines for the susceptibility of pneumococcal isolates to either penicillin or cefotaxime established by the 1993 NCCLS breakpoint recommendations. Because of this study and other similar findings, the NCCLS adopted more clinically relevant guidelines in 1994.

Full Text

The Full Text of this article is available as a PDF (190.3 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Allen K. D. Penicillin-resistant pneumococci. J Hosp Infect. 1991 Jan;17(1):3–13. doi: 10.1016/0195-6701(91)90072-g. [DOI] [PubMed] [Google Scholar]
  2. Appelbaum P. C. Antimicrobial resistance in Streptococcus pneumoniae: an overview. Clin Infect Dis. 1992 Jul;15(1):77–83. doi: 10.1093/clinids/15.1.77. [DOI] [PubMed] [Google Scholar]
  3. Appelbaum P. C. World-wide development of antibiotic resistance in pneumococci. Eur J Clin Microbiol. 1987 Aug;6(4):367–377. doi: 10.1007/BF02013089. [DOI] [PubMed] [Google Scholar]
  4. Asmar B. I., Thirumoorthi M. C., Buckley J. A., Kobos D. M., Dajani A. S. Cefotaxime diffusion into cerebrospinal fluid of children with meningitis. Antimicrob Agents Chemother. 1985 Jul;28(1):138–140. doi: 10.1128/aac.28.1.138. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Breiman R. F., Butler J. C., Tenover F. C., Elliott J. A., Facklam R. R. Emergence of drug-resistant pneumococcal infections in the United States. JAMA. 1994 Jun 15;271(23):1831–1835. [PubMed] [Google Scholar]
  6. Caputo G. M., Appelbaum P. C., Liu H. H. Infections due to penicillin-resistant pneumococci. Clinical, epidemiologic, and microbiologic features. Arch Intern Med. 1993 Jun 14;153(11):1301–1310. [PubMed] [Google Scholar]
  7. Chesney P. J. The escalating problem of antimicrobial resistance in Streptococcus pneumoniae. Am J Dis Child. 1992 Aug;146(8):912–916. doi: 10.1001/archpedi.1992.02160200034022. [DOI] [PubMed] [Google Scholar]
  8. Craig W. A. Interrelationship between pharmacokinetics and pharmacodynamics in determining dosage regimens for broad-spectrum cephalosporins. Diagn Microbiol Infect Dis. 1995 May-Jun;22(1-2):89–96. doi: 10.1016/0732-8893(95)00053-d. [DOI] [PubMed] [Google Scholar]
  9. Friedland I. R., McCracken G. H., Jr Management of infections caused by antibiotic-resistant Streptococcus pneumoniae. N Engl J Med. 1994 Aug 11;331(6):377–382. doi: 10.1056/NEJM199408113310607. [DOI] [PubMed] [Google Scholar]
  10. Friedland I. R., Shelton S., Paris M., Rinderknecht S., Ehrett S., Krisher K., McCracken G. H., Jr Dilemmas in diagnosis and management of cephalosporin-resistant Streptococcus pneumoniae meningitis. Pediatr Infect Dis J. 1993 Mar;12(3):196–200. doi: 10.1097/00006454-199303000-00004. [DOI] [PubMed] [Google Scholar]
  11. From the Centers for Disease Control and Prevention. Drug-resistant Streptococcus pneumoniae--Kentucky and Tennessee, 1993. JAMA. 1994 Feb 9;271(6):421–422. [PubMed] [Google Scholar]
  12. From the Centers for Disease Control and Prevention. Prevalence of penicillin-resistant Streptococcus pneumoniae--Connecticut, 1992-1993. JAMA. 1994 May 25;271(20):1572–1572. [PubMed] [Google Scholar]
  13. Haglund L. A., Istre G. R., Pickett D. A., Welch D. F., Fine D. P. Invasive pneumococcal disease in central Oklahoma: emergence of high-level penicillin resistance and multiple antibiotic resistance. Pneumococcus Study Group. J Infect Dis. 1993 Dec;168(6):1532–1536. doi: 10.1093/infdis/168.6.1532. [DOI] [PubMed] [Google Scholar]
  14. Jacobs M. R. Treatment and diagnosis of infections caused by drug-resistant Streptococcus pneumoniae. Clin Infect Dis. 1992 Jul;15(1):119–127. doi: 10.1093/clinids/15.1.119. [DOI] [PubMed] [Google Scholar]
  15. Jones R. N., Barry A. L., Packer R. R. The activity of cefotaxime and desacetylcefotaxime alone and in combination against anaerobes and staphylococci. Diagn Microbiol Infect Dis. 1984 Jun;2(3 Suppl):37S–46S. [PubMed] [Google Scholar]
  16. Jorgensen J. H., Ferraro M. J., McElmeel M. L., Spargo J., Swenson J. M., Tenover F. C. Detection of penicillin and extended-spectrum cephalosporin resistance among Streptococcus pneumoniae clinical isolates by use of the E test. J Clin Microbiol. 1994 Jan;32(1):159–163. doi: 10.1128/jcm.32.1.159-163.1994. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Klugman K. P. Pneumococcal resistance to antibiotics. Clin Microbiol Rev. 1990 Apr;3(2):171–196. doi: 10.1128/cmr.3.2.171. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Leggiadro R. J., Barrett F. F., Chesney P. J., Davis Y., Tenover F. C. Invasive pneumococci with high level penicillin and cephalosporin resistance at a mid-south children's hospital. Pediatr Infect Dis J. 1994 Apr;13(4):320–322. [PubMed] [Google Scholar]
  19. Macias E. A., Mason E. O., Jr, Ocera H. Y., LaRocco M. T. Comparison of E test with standard broth microdilution for determining antibiotic susceptibilities of penicillin-resistant strains of Streptococcus pneumoniae. J Clin Microbiol. 1994 Feb;32(2):430–432. doi: 10.1128/jcm.32.2.430-432.1994. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Mason E. O., Jr, Kaplan S. L., Lamberth L. B., Tillman J. Increased rate of isolation of penicillin-resistant Streptococcus pneumoniae in a children's hospital and in vitro susceptibilities to antibiotics of potential therapeutic use. Antimicrob Agents Chemother. 1992 Aug;36(8):1703–1707. doi: 10.1128/aac.36.8.1703. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Musher D. M. Infections caused by Streptococcus pneumoniae: clinical spectrum, pathogenesis, immunity, and treatment. Clin Infect Dis. 1992 Apr;14(4):801–807. doi: 10.1093/clinids/14.4.801. [DOI] [PubMed] [Google Scholar]
  22. Neu H. C. The crisis in antibiotic resistance. Science. 1992 Aug 21;257(5073):1064–1073. doi: 10.1126/science.257.5073.1064. [DOI] [PubMed] [Google Scholar]
  23. Parkinson A. J., Davidson M., Fitzgerald M. A., Bulkow L. R., Parks D. J. Serotype distribution and antimicrobial resistance patterns of invasive isolates of Streptococcus pneumoniae: Alaska 1986-1990. J Infect Dis. 1994 Aug;170(2):461–464. doi: 10.1093/infdis/170.2.461. [DOI] [PubMed] [Google Scholar]
  24. Peretti P., Sueri L., Tosi M., Ciammarughi R., Cadeo G. P., Milanesi B. Cefotaxime in the cerebrospinal fluid and serum in patients with purulent meningitis. J Antimicrob Chemother. 1984 Sep;14 (Suppl B):117–123. doi: 10.1093/jac/14.suppl_b.117. [DOI] [PubMed] [Google Scholar]
  25. Simberkoff M. S. Drug-resistant pneumococcal infections in the United States. A problem for clinicians, laboratories, and public health. JAMA. 1994 Jun 15;271(23):1875–1876. [PubMed] [Google Scholar]
  26. Sloas M. M., Barrett F. F., Chesney P. J., English B. K., Hill B. C., Tenover F. C., Leggiadro R. J. Cephalosporin treatment failure in penicillin- and cephalosporin-resistant Streptococcus pneumoniae meningitis. Pediatr Infect Dis J. 1992 Aug;11(8):662–666. [PubMed] [Google Scholar]
  27. Tan T. Q., Mason E. O., Jr, Kaplan S. L. Penicillin-resistant systemic pneumococcal infections in children: a retrospective case-control study. Pediatrics. 1993 Dec;92(6):761–767. [PubMed] [Google Scholar]
  28. Tan T. Q., Schutze G. E., Mason E. O., Jr, Kaplan S. L. Antibiotic therapy and acute outcome of meningitis due to Streptococcus pneumoniae considered intermediately susceptible to broad-spectrum cephalosporins. Antimicrob Agents Chemother. 1994 May;38(5):918–923. doi: 10.1128/aac.38.5.918. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Thompson J. W., Lewno M. J., Schutze G. E. Antibiotic-resistant pneumococcal disease at Arkansas Children's Hospital, 1990 to 1993. Pediatr Infect Dis J. 1994 May;13(5):408–409. doi: 10.1097/00006454-199405000-00013. [DOI] [PubMed] [Google Scholar]
  30. Todd P. A., Brogden R. N. Cefotaxime. An update of its pharmacology and therapeutic use. Drugs. 1990 Oct;40(4):608–651. doi: 10.2165/00003495-199040040-00008. [DOI] [PubMed] [Google Scholar]
  31. Trang J. M., Jacobs R. F., Kearns G. L., Brown A. L., Wells T. G., Underwood F. L., Kluza R. B. Cefotaxime and desacetylcefotaxime pharmacokinetics in infants and children with meningitis. Antimicrob Agents Chemother. 1985 Dec;28(6):791–795. doi: 10.1128/aac.28.6.791. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Welby P. L., Keller D. S., Cromien J. L., Tebas P., Storch G. A. Resistance to penicillin and non-beta-lactam antibiotics of Streptococcus pneumoniae at a children's hospital. Pediatr Infect Dis J. 1994 Apr;13(4):281–287. doi: 10.1097/00006454-199404000-00007. [DOI] [PubMed] [Google Scholar]

Articles from Antimicrobial Agents and Chemotherapy are provided here courtesy of American Society for Microbiology (ASM)

RESOURCES