Forty-six consecutive patients with pneumococcal meningitis were treated with cefotaxime (CTX). Ages ranged from 1-79 years: 29 adults, six adolescents, six children and five infants. Underlying diseases were found in 38 patients (82.6%). Twenty-six patients (56.5%) were admitted in coma. All isolates were sensitive to CTX, with MICs for 12 strains ranging from 0.01 to 0.08 mg/l. CTX was used as single-drug therapy for 12 to 27 days-mean 15 days. The daily dose of CTX was 200 mg/kg, in four or six equal intravenous doses. CTX penetration into the CSF was studied in four patients. 40 patients (87.0%) were cured. The mortality rate was 13.0%. All dead patients had been admitted in coma. The mortality rate in comatose patients was 23.1%. CSF sterilization was obtained within 72 h after starting treatment, mostly (90.7%) in the first 48 h. No serious side-effects were observed. The study proves that CTX is a safe and very successful therapy for pneumococcal meningitis.