TABLE 4.

Analysis of treatment failures^a

No. (yr)	Age/sex	Source	MIC PENb (mg/L)	MIC CTX (mg/L)	Serotype	Initial therapy	Observations	Second therapy	Outcome
1 (1977)	50/F	AOM	0.03	0.03	NA	PEN	Relapse due to unsolved otological problem	PEN	Cured, after ENT surgery
2 (1984)	52/F	AOM	0.03	0.03	3	PEN	Relapse due to unsolved otological problem	PEN	Cured, after ENT surgery
3 (1984)	11/F	Unknown	4	0.5	23	PEN	No improvement with PEN, fever persisted, and relapsed	High dose CTX/VAN	Cured
4 (1988)	66/F	Unknown	4	2	9V	VAN	Clinical failure with VAN	High dose CTX	Cured
5 (1989)	27/M	Fistula	0.03	0.03	3	VAN	Clinical failure with VAN	PEN	Cured
6 (1989)	17/M	Fistula	0.03	0.03	18C	VAN	Clinical failure with VAN	PEN	Cured
7 (1991)	37/M	Fistula	2	1	6	CRO	Clear initial improvement, 48 h of therapy, reappearance of fever, reduced consciousness, and greater meningeal signs. CSF Gram stain at 72 h indicated diplococci. CRO dose represented 65 mg/Kg.	High dose CTX	Cured
8 (1992)	62/F	Fistula	4	2	23F	CRO	After clear initial improvement, the fever, coma, and meningeal signs reappeared and worsened. CRO dose represented 55 mg/Kg.	High dose CTX	Cured
9 (1994)	56/F	AOM	2	1	6B	VAN+RIF	Failure due to low VAN serum levels	High dose CTX	Cured

^aNo cases of failures after the implementation of high dose CTX as empirical therapy.

^bPEN, penicillin; CTX, cefotaxime; VAN, vancomycin; CRO, ceftriaxone; RIF, rifampin.