Paap C M, Bosso J A
Division of Clinical Pharmacy, University of Texas College of Pharmacy, Austin.
Drugs. 1992 May;43(5):700-12. doi: 10.2165/00003495-199243050-00006.
Neonatal bacterial meningitis has a relatively low incidence in developed countries, but continues to cause morbidity and mortality despite advances in antimicrobial therapy. Bacterial pathogens commonly associated with neonatal meningitis include Group B streptococci, Escherichia coli K1 and other coliforms, Listeria monocytogenes and staphylococci. As it can be difficult to differentiate meningitis from septicaemia in neonates, empirical antibiotic therapy should be effective for both. Selection of an empirical antibiotic regimen should be based on: (a) bacterial prevalence and susceptibility; (b) drug characteristics; (c) postnatal age at the onset of disease; and (d) patient-specific factors. A penicillin in combination with an aminoglycoside or cefotaxime is commonly used in empirical therapies. The increased risk of staphylococcal infection in older neonates requires consideration of an antistaphylococcal antibiotic in the empirical therapy regimen. Once a causative organism has been identified, antimicrobial therapy should be directed towards that pathogen. Duration of therapy remains empirical, but should be at least 7 days for documented bacterial meningitis. Viral meningitis continues to have a high mortality despite the availability of antiviral agents. Adjunctive therapies may further reduce the morbidity and mortality of meningitis. While most of these therapeutic options have not been investigated in neonates, they may prove to be of benefit in the future. Anti-inflammatory agents, such as glucocorticoids, nonsteroidal anti-inflammatory agents and immunoglobulin, may modulate the inflammatory response of a meningeal infection. Other possible therapies in neonatal meningitis include cerebral blood flow modulators and disease prevention with maternal vaccines and perinatal antibiotics. Practical aspects of drug therapy such as route of administration and serum drug concentration monitoring can improve both drug therapy and patient outcome. While antibiotics have greatly improved the treatment outcome of neonatal meningitis, it is clear that additional intervention will be required to increase cure rates and reduce sequelae.
新生儿细菌性脑膜炎在发达国家的发病率相对较低，但尽管抗菌治疗取得了进展，它仍会导致发病和死亡。通常与新生儿脑膜炎相关的细菌病原体包括B族链球菌、大肠杆菌K1和其他大肠菌、单核细胞增生李斯特菌和葡萄球菌。由于新生儿脑膜炎与败血症难以区分，经验性抗生素治疗应对两者均有效。经验性抗生素治疗方案的选择应基于：（a）细菌流行情况和敏感性；（b）药物特性；（c）疾病发作时的出生后年龄；以及（d）患者的具体因素。经验性治疗中常用青霉素联合氨基糖苷类或头孢噻肟。年龄较大的新生儿葡萄球菌感染风险增加，因此经验性治疗方案中需要考虑使用抗葡萄球菌抗生素。一旦确定了病原体，抗菌治疗应针对该病原体。治疗持续时间仍基于经验，但对于确诊的细菌性脑膜炎，治疗时间应至少为7天。尽管有抗病毒药物，但病毒性脑膜炎的死亡率仍然很高。辅助治疗可能会进一步降低脑膜炎的发病率和死亡率。虽然这些治疗选择大多尚未在新生儿中进行研究，但它们可能在未来被证明是有益的。抗炎药物，如糖皮质激素、非甾体抗炎药和免疫球蛋白，可能会调节脑膜感染的炎症反应。新生儿脑膜炎的其他可能治疗方法包括脑血流调节剂以及通过母体疫苗和围产期抗生素进行疾病预防。药物治疗的实际方面，如给药途径和血清药物浓度监测，可以改善药物治疗效果和患者预后。虽然抗生素大大改善了新生儿脑膜炎的治疗结果，但显然还需要额外的干预措施来提高治愈率并减少后遗症。
