ABSTRACT
Sequential bacteriological observations were made on the cerebrospinal fluid (CSF) of 28 patients with pneumococcal meningitis treated with high doses of penicillin for 2 weeks. The organism was isolated from the CSF of four patients 48 h or more after the start of treatment and from a further patient 48 h after treatment was stopped. Positive cultures were obtained in spite of the demonstration in the CSF of penicillin at a concentration well above the minimum inhibitory concentration for the organism isolated. Persistence of bacteria and their products in the CSF of patients with pneumococcal meningitis contrasts with the rapid clearance of bacteria from the CSF of patients with meningococcal meningitis and may contribute to the difference in the prognosis of these forms of meningitis.
Subject(s)
Cerebrospinal Fluid/microbiology , Meningitis, Pneumococcal/microbiology , Streptococcus pneumoniae/isolation & purification , Adolescent , Adult , Age Factors , Antibodies, Bacterial/analysis , Child , Female , Humans , Male , Meningitis, Pneumococcal/cerebrospinal fluid , Meningitis, Pneumococcal/drug therapy , Middle Aged , Penicillins/cerebrospinal fluid , Penicillins/therapeutic use , Radioimmunoassay , Sex Factors , Streptococcus pneumoniae/drug effectsABSTRACT
A single injection of a long-acting preparation of penicillin (Triplopen) was compared with a five-day course of crystalline and procaine penicillin in the treatment of meningococcal meningitis. The clinical response of patients treated with Triplopen was very similar to that of patients treated with crystalline penicillin and much more convenient to administer. However, four patients treated with Triplopen had a positive CSF culture 48 or 72 hours after their injection. One injection of Triplopen cannot, therefore, be recommended as an entirely safe form of treatment for meningococcal meningitis unless patients can be carefully followed.