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June 19, 1996

Pediatrics and Adolescent Medicine

Author Affiliations

The Johns Hopkins University School of Medicine, Baltimore, Md

JAMA. 1996;275(23):1841-1842. doi:10.1001/jama.1996.03530470069041

Infections caused by penicillin- and cephalosporin-resistant Streptococcus pneumoniae are becoming important clinical problems in a number of areas of the country and of the world. [See also Infectious Diseases.—Ed.] A study of invasive pneumococcal infections in children with sickle cell disease in Memphis, Tenn,1 described 6 children who were infected with multiply-resistant pneumococcus. Two of these children died. A review of the experience in this sickle cell disease treatment center showed that 15% of the strains that caused pneumococcal sepsis during a 4½-year period were resistant to penicillin. Vancomycin hydrochloride remains uniformly effective against pneumococcus, and the authors suggest that vancomycin be added to cefotaxime sodium in children with sickle cell disease who have meningitis or another "potentially serious focus of infection such as pneumonia," evidence of overwhelming infection, or a history of sepsis.

Penicillin-resistant pneumococci are generally susceptible to the serum concentrations that can be achieved with