The first penicillin-resistant Streptococcus pneumoniae strain was isolated in 1967. Since then, however, there have been many reports of treatment failure in patients with pneumococcal infections caused by strains resistant to penicillin and other antimicrobial agents such as chloramphenicol, macrolides, trimethoprim-sulfamethoxazole, and cephalosporins. As a result, the selection of antimicrobial agents for the treatment of infections caused by these organisms has become increasingly difficult. In particular, the emergence of pneumococci-resistant to broad-spectrum cephalosporins has limited the antibiotic choices for the treatment of pneumococcal meningitis.

Patients with central nervous system (CNS) infections, regardless of the etiology (bacterial, viral, or other), generally present with similar clinical features. The systemic signs of CNS infection include fever, malaise, and impairment of essential organs (heart, lung, liver, or kidney function). For older children and adults, the classic signs and symptoms suggesting CNS infection include headache; stiff neck; fever or hypothermia; changes in mental status, including hyperirritability evolving into lethargy and coma; seizures; and focal sensory and motor deficits.

Infants and young children, however, may lack obvious signs of meningitis, and present with simple temperature instability rather than fever. Otherwise, lethargy, irritability, vomiting, and poor feeding are often signs of CNS involvement in this group. Nuchal rigidity or a bulging fontanelle is present in <50% of infants and young children with meningitis.