Ceftriaxone treatment failure of meningitis due to penicillin and ceftriaxone resistant streptococcus pneumonia

Third generation cephalosporins (cefotaxime and ceftriaxone in particular) are widely used for empirical treatment of bacterial meningitis. However, reports from different parts of the world documented occurrence of meningitis due to Streptococcus pneumonia resistant to third generation cephalosporins with Minimum Inhibitory Concentration equal to or greater than 2 microgram/ml.2-12 We are reporting a case of meningitis in the Middle East, caused by Streptococcus pneumonia with intermediate resistance to ceftriaxone and penicillin, where combined and prolonged course of ceftriaxone (14 days) with penicillin (10 days) failed to clear the cerebrospinal fluid.