Meningitis caused by Streptococcus pneumoniae showing high level resistance to penicillin.

A case of meningitis caused by a strain of Streptococcus pneumoniae (SPn) showing high level resistance to penicillin is described. The patient responded to a combination of high dose penicillin and ceftriaxone. After reviewing the Australian situation and the world literature, we propose that empiric treatment of SPn meningitis in Australia should consist of high dose penicillin plus a third generation cephalosporin, with appropriate modification once the identification of the organism and its susceptibilities are confirmed.