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Pneumococcal Meningitis — SCE Infectious Diseases MCQ

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HardCNS InfectionPneumococcal MeningitisSCE Infectious Diseases

A 68-year-old man develops acute bacterial meningitis. CSF culture grows Streptococcus pneumoniae with Penicillin MIC 2 mg/L (intermediate). He was started on IV Ceftriaxone 2 g BD. How should this antibiotic choice be interpreted given the susceptibility?

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Correct answer: A — Ceftriaxone remains appropriate for pneumococcal meningitis even with Penicillin intermediate resistance

Penicillin intermediate resistance in S. pneumoniae does NOT necessarily imply Ceftriaxone resistance — separate breakpoints apply. For pneumococcal meningitis, EUCAST Ceftriaxone breakpoints are more stringent than for non-meningeal infections (susceptible ≤0.5 mg/L for meningitis vs ≤2 mg/L for non-meningeal). If the Ceftriaxone MIC is ≤0.5 mg/L (which must be confirmed), Ceftriaxone remains appropriate. If Ceftriaxone MIC is >0.5 mg/L, Vancomycin should be added.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/infections