Invasive pneumococcal disease; Current management challenges in a case of severe infection

An increase in invasive pneumococcal disease [IPD] requiring intensive care admissions has been reported recently. This increasing prevalence of pneumococci with decreased susceptibility to penicillin and to cefotaxime or ceftriaxone has complicated the management of pneumococcal invasive disease including meningitis. Streptococcus pneumoniae is the leading cause of bacterial meningitis in children beyond the neonatal period. Although the use of third generation cephalosporins as initial empiric therapy for suspected pneumococcal meningitis is currently recommended, the failure of this treatment is frequently reported. Due to its excellent penetration into the cere b rospinal fluid, vancomycin is now being recommended in the treatment of meningitis by the Infectious Disease Academy. We report a case of a healthy Kuwaiti infant who had pneumococcal meningitis and septicemia, with a rapid progressive deterioration, in spite of initiating therapy within 24 hours of the onset of symptoms and signs of meningitis