Primary
meningitis in children is caused by two gram-negative bacterial species, Neisseria meningitidis and Haemophilus influenzae, and one gram-positive bacterial species Streptococcus pneumoniae. Despite optimal
penicillin susceptibility, with few exceptions, therapeutic results in
pneumococcal meningitis are by far worse than with the other two pathogens. Therefore, and because of the detection of
penicillin-resistant rods, the study of alternatives in
therapy is justified and was started with
cefotaxime. Including six of our own patients, there are reports on 87 patients in the literature suffering from S. pneumoniae
meningitis who were treated with
cefotaxime monotherapy. Results of these studies will be analyzed. As none of these patients belonged to a prospective controlled study group, final evaluation in comparison with
penicillin therapy remains open. There are also several reports on successful treatment of group B streptococcus
meningitis with
cefotaxime, although there is no need to abandon
penicillin therapy. Staphylococcus aureus and Staphylococcus epidermidis
meningitis, usually secondary in shunted
hydrocephalus,
brain tumors,
brain injury or other causes, should not be treated with
cefotaxime because of its limited activity on these bacteria. Listeria monocytogenes and Streptococcus faecalis are primarily
cefotaxime-resistant, and neonatal
meningitis of unknown origin, therefore, should not be treated with
cefotaxime alone as long as these pathogens cannot be excluded.