The potentially deadly and infectious disease is preventable through vaccination 

Published in late February in the journal Critical Care Science, a study conducted by the D’Or Institute for Research and Education (IDOR), spanning 16 hospitals in Rio de Janeiro, raised concerns about the treatment of pneumococcal meningitis, one of the most severe forms of the disease.

The research analyzed 411 samples of the bacterium Streptococcus pneumoniae, the leading cause of bacterial meningitis in both children and adults. It found that 14% of the isolates were resistant to ceftriaxone, a widely used first-line antibiotic for treating meningitis. 

Samples were collected between 2021 and 2023, with the aim of mapping the prevalence of antibiotic-resistant pneumococci in hospital settings. The findings are particularly timely: in April, the World Health Organization (WHO) released its first global roadmap to tackle meningitis, emphasizing early diagnosis, timely treatment, and long-term care improvements. 

A serious and infectious disease
Although effective treatments and vaccines exist, bacterial meningitis remains one of the deadliest forms of the disease, potentially causing death within 24 hours. In 2019, the WHO recorded 1.6 million cases of bacterial meningitis worldwide and 240,000 deaths — roughly one in six patients. About 20% of survivors are left with long-term sequelae such as hearing loss, cognitive and motor impairments, or cerebral palsy. 

“Pneumococcal meningitis is not as contagious as meningococcal meningitis,” says Dr. Pedro Peloso, the study’s first author and a medical scientist at IDOR, “but Streptococcus pneumoniae can still spread via respiratory droplets and cause asymptomatic colonization — especially in children, who may unknowingly transmit the pathogen to vulnerable groups like the elderly or immunosuppressed.” 

Antibiotic resistance is key in fighting the disease
In addition to ceftriaxone resistance, laboratory tests revealed that 29% of isolates were resistant to penicillin. Resistance to ampicillin (22%) and trimethoprim-sulfamethoxazole (26%) was also observed in cases of pneumonia and other pneumococcal infections. However, no resistance was found to vancomycin, linezolid, or teicoplanin — drugs considered the last line of defense. 

“Monitoring antibiotic resistance is essential for public health,” Dr. Peloso explains. “It helps prevent therapeutic failure and guides public policies and vaccination strategies. Resistance to first-line treatments like ceftriaxone can lead to rapid clinical deterioration in serious infections like meningitis. Surveillance of resistant S. pneumoniae serotypes also informs the effectiveness of current vaccines and potential updates.” 

The findings support the use of combination therapies in the initial treatment of meningitis, in line with international guidelines. They also provide a strong basis for shaping public health policies, enhancing microbial surveillance, and refining immunization strategies in Rio de Janeiro and beyond.