Due to a worldwide increasing number of cephalosporin resistant Streptococcus (S) pneumoniae strains, it appears necessary to modify the current treatment of pneumococcal meningitis. The authors recommend an initial antimicrobial regimen associating cefotaxime or ceftriaxone to vancomycin in any case of bacterial meningitis in which S pneumoniae appears to be involved (Gram positive cocci on direct examination of the CSF and/or presence of soluble bacterial antigen). There is also a need for a reappraisal of the duration of the treatment which, in any case, should not be shorter than 10 days. In the case of meningitis due to a penicillin resistant S pneumoniae, lumbar puncture must be repeated until sterilisation of the CSF.