S. pneumoniae is the leading cause of bacterial meningitis in elderly persons. This study involved the surveillance of a population of 34 million people in the USA in 1986.

S. pneumoniae was the cause of nearly 40% of cases of meningitis among the 30 – 59 year old group, and of nearly 50% of the cases among elderly patients (aged > 60 years).

In western countries (where Hib vaccination programmes have been implemented for several years), S. pneumoniae is the most common cause of bacterial meningitis.

Where vaccination programmes against Haemophilus influenzae type b (Hib) have been implemented, S. pneumoniae is now the most common cause of bacterial meningitis.

The case fatality rate for pneumococcal meningitis is high, particularly among adults.

Treatment usually begins before the aetiology of the disease is known. The choice of therapy should be governed by knowledge of local patterns of resistance.

Oral amoxycillin is often used to treat pneumonia in patients treated in the community. Hospitalised patients often receive multiple antibiotics administered intravenously (e.g. cephalosporin + erythromycin)

Because of antibiotic resistance, penicillin is also no longer the first line of treatment for suspected pneumococcal meningitis. A third-generation cephalosporin is often used now.