La Résistance Aux Antibiotiques Modifie-T-elle Le Pronostic Des Méningites Et Des Otites Moyennes Aiguës À S. Pneumoniae ?

The alarming increase of penicillin resistant S. pneumoniae (PRP), and most often multi-resistant strains, in France has changed antibiotherapy strategy in community acquired infections. If beta-lactam treatment for pneumonia and bacteremia is rather effective, it is different for meningitis and acute otitis media (AOM) due to PRP. In these two diseases, antibiotic concentrations on infection site can be inferior to MICs of PRP and be responsible for clinical and bacteriological failure. In PRP meningitis, the frequency of CSF bacteriological eradication failure is linked to first line treatment. Increasing dosage of third generation cephalosporins (3GC) cefotaxime, or ceftriaxone, and search for a synergetic combination (3GC + vancomycin) have shortened the duration of CSF sterilization. In AOM, the rate of therapeutic failure is linked to the level of resistance of PRP strains. Three steps must be followed in order to control an effective antibiotherapy: determining AOM risk factors due to PRP, prescribing the most active drugs, and if signs and symptoms persist at day 2 or 3, carrying out tympanocentesis with bacteriologic sampling (in order to isolate the strain responsible for the failure and to test its antibiotic susceptibility).