Fuller David G, Duke Trevor, Shann Frank, Curtis Nigel
Department of General Medicine, Royal Children's Hospital, Melbourne, Australia.
Ann Trop Paediatr. 2003 Dec;23(4):233-53. doi: 10.1179/027249303225007752.
Bacterial meningitis causes 125,000 deaths each year in infants and young children and 96% of these occur in less developed countries where up to 50% of children with this disease die and 25-50% of survivors have neurological sequelae. Although 3rd-generation cephalosporins are optimal empirical therapy for bacterial meningitis, they are unaffordable in many developing countries. The majority of children worldwide are currently treated with cheaper alternatives. This paper reviews the challenges facing clinicians treating bacterial meningitis in developing countries, highlighting the problem of changing patterns of antibiotic resistance. In particular, it details the evidence for the use of chloramphenicol and 3rd-generation cephalosporins.
细菌性脑膜炎每年导致12.5万名婴幼儿死亡，其中96%发生在欠发达国家，这些国家中患此病的儿童死亡率高达50%，25%至50%的幸存者有神经后遗症。尽管第三代头孢菌素是治疗细菌性脑膜炎的最佳经验性疗法，但在许多发展中国家却难以承受。目前，全球大多数儿童使用更便宜的替代药物进行治疗。本文综述了发展中国家治疗细菌性脑膜炎的临床医生所面临的挑战，强调了抗生素耐药性模式不断变化的问题。特别是，详细阐述了使用氯霉素和第三代头孢菌素的证据。
