A THERAPEUTIC APPROACH TO MENINGOENCEPHALITIS BY Streptococcus pneumoniae IN BRAZIL

Abstract

Introduction: Acute bacterial meningoencephalitis (ABM) are severe infections caused by microorganisms that are capable of reaching the meninges, as well as the brain. They areconsidered medical emergencies that require early diagnosis and immediate treatment. However, medical professionals have routinely encountered difficulties resulting from the Streptococcus pneumoniae’s antimicrobial resistance in the medical practice, becoming a public health problem in Brazil. The present article has the objective of revising literature and compiling data on S. pneumoniae’s resistance in ABM cases, with the intent of assisting the decision-making process on which therapy should be adopted. Methods: The study was conducted through the revision of literature regarding the treatment of ABM in humans published in the last 20 years, found in the PubMed/Medline, LILACS and SciELO digital databases. The first selection of articles was carried out by analyzing the titles and abstracts. The selected studies were read completely to determine their eligibility. Results and Discussions: The 45 selected articles described varying resistance of S. pneumoniae's to penicillin and ceftriaxone, which can reach approximately 50% to the first drug. The SIREVA Project (2016), developed in Brazil, deserves do to commended for being able to identify the following resistance patterns of the isolated pathogen in ABM cases: (1) 31,% to penicillins (sample of 334 patients), and (2) intermediate and high resistance to ceftriaxone, 6.9% and 5.6% respectively (sample of 320 patients). Despite the infrequent occurrence, present studies document the emergence of resistance mechanisms in pathogen strains to vancomycin. Nevertheless, the studies conducted in Brazil showed that the S. pneumoniae strains were completely sensitive to the previously mentioned drug. Conclusion: The association of ceftriaxone and vancomycin should be considered the best option to treat pneumococcal ABM in Brazil, due to the severity of the condition and the rising resistance of the pathogen to cephalosporins.