Vancomicina, Uma Opção no Tratamento Empírico da Meningite Aguda Bacteriana nos Adultos em Portugal?

Abstract

Introduction: Acute meningitis is an infection with high morbidity and mortality rate. Empiric treatment is crucial for the prognosis, and the initial choice of antibiotic depends on patient-related factors and the regional epidemiology of resistance of Pneumococcus to penicillin. Materials and Methods: The articles on the resistance rates of Pneumococcus to penicillin and their influence on the empiric treatment of acute bacterial meningitis in adults were searched in the PubMed database, and other publications and guidelines. Results: Pneumococcus infection resistant to penicillin is associated with a higher mortality rate. Countries such as Spain, France and the United States of America have shown high rates of resistance of this pathogen to penicillin, although there has been a global decrease in the mortality rate and incidence of invasive pneumococcal disease. In Portugal, there has been no statistically increase in the resistance rate of Pneumococcus, remaining with a low resistance rate when compared with other countries. The rate of resistance in Portugal to third generation cephalosporins remains <1%, which justifies the use of these antibiotics as monotherapy or in combination with vancomycin in the empirical antibiotic of this infection. Discussion: Since there has been no statistically significant increase in the resistance rate of Pneumococcus to penicillin in recent years and resistance to cephalosporins remains low, the combination of vancomycin and third generation cephalosporins is not justified as a mandatory empirical treatment in Portugal.