Chang M J, Escobedo M, Anderson D C, Hillman L, Feigin R D
Pediatrics. 1975 Nov;56(5):695-9.
Mortality from neonatal meningitis due to gram-negative microorganisms remains 50% despite use of aminoglycoside antibiotics. Blood was obtained on 238 occasions from 77 neonates with putative or documented sepsis; paired blood and cerebrospinal fluid (CSF) samples were obtained on 14 occasions from ten neonates with meningitis. Kanamycin and gentamicin were measured by a radioisotopic assay procedure. Kanamycin was administered at 15 mg/kg/day in three divided doses intravenously; serum concentrations peaked at one hour (mean, 7.77mug/ml). Gentamicin was administered at 7.5 mg/kg/day in three divided doses intravenously; serum concentrations peaked at two hours (mean, 5.34mug/ml). Both aminoglycosides generally were nondetectable within the CSF; survival of neonates with gram-negative meningitis correlated specifically with the sensitivity of their isolates to ampicillin which was administered concurrently. This study suggests that alternative approaches to the treatment of neonatal sepsis should be explored; administration of an antibiotic which crosses the blood-cerebrospinal fluid barrier more readily should be considered.
尽管使用了氨基糖苷类抗生素，但革兰氏阴性微生物引起的新生儿脑膜炎死亡率仍为50%。对77例疑似或确诊败血症的新生儿进行了238次采血；对10例脑膜炎新生儿进行了14次配对血样和脑脊液（CSF）采样。采用放射性同位素测定法检测卡那霉素和庆大霉素。卡那霉素静脉注射，剂量为15mg/kg/天，分三次给药；血清浓度在1小时达到峰值（平均7.77μg/ml）。庆大霉素静脉注射，剂量为7.5mg/kg/天，分三次给药；血清浓度在2小时达到峰值（平均5.34μg/ml）。脑脊液中通常检测不到这两种氨基糖苷类药物；革兰氏阴性脑膜炎新生儿的存活与同时使用的氨苄西林对其分离菌株的敏感性密切相关。本研究表明，应探索治疗新生儿败血症的替代方法；应考虑使用更容易穿过血脑屏障的抗生素。
