Treatment of Streptococcal Meningitis Caused by Penicillin-Susceptible Streptococcus pneumoniae (MIC <0.1 μg/mL)

This protocol addresses bacterial meningitis due to Streptococcus pneumoniae where susceptibility testing confirms a penicillin minimum inhibitory concentration (MIC) below 0.1 μg/mL — indicating a fully penicillin-susceptible isolate.

Confirmed penicillin susceptibility at this threshold informs antibiotic selection, allowing a targeted approach. Adjunctive therapy to reduce inflammatory sequelae is a key component of management alongside the antibiotic course.

Treatment approach (partial overview)

The regimen centres on a penicillin or related beta-lactam agent as primary therapy, with alternative agents available. Adjunctive corticosteroid therapy is recommended for both adults and children, started with the first dose of antibiotics — the complete agent selection, dosing, and duration are in the full protocol.

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References

DOI: 10.1016/j.cmi.2016.01.007

Streptococcus pneumoniae
Penicillin susceptible (MIC <0.1 μg/mL)
Penicillin or amoxicillin/ampicillin
Empiric treatment with dexamethasone is strongly recommended for all adults (10 mg qid for 4 days) and children (0.15 mg/kg qid for 4 days) with acute bacterial meningitis in the setting of high-income countries.
Treatment with dexamethasone is strongly recommended to be initiated with the first dose of antibiotic treatment.

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