Yogev Ram, Guzman-Cottrill Judith
Feinberg School of Medicine, Children's Memorial Hospital, Chicago, Illinois 60614, USA.
Drugs. 2005;65(8):1097-112. doi: 10.2165/00003495-200565080-00005.
Acute bacterial meningitis is still an important cause of morbidity and mortality in children worldwide. Recently, Haemophilus influenzae type b (Hib), once a common cause of meningitis, has virtually disappeared in developed nations, reflecting the overwhelming success of Hib vaccination. Unfortunately, Hib remains a significant pathogen in resource-poor countries. The introduction of the conjugated pneumococcal vaccine in 2000 may lead to similar future trends as witnessed with Hib. As the resistance of Streptococcus pneumoniae to penicillin and cephalosporins continues to evolve, vancomycin has become an important antibacterial in the treatment of bacterial meningitis. The unreliable penetration of this agent into cerebrospinal fluid is of concern, which is compounded by the controversial use of corticosteroids in paediatric meningitis. Some data suggest that in certain situations the addition of rifampicin (rifampin) to ceftriaxone may be a better choice. While dexamethasone is now considered the standard adjunctive therapy in the treatment of pneumococcal meningitis in adult patients, the benefit in children is not so clear and remains controversial; thus, there is no definitive paediatric recommendation. Several anti-inflammatory agents currently under investigation may be used in the future as adjunctive therapy for bacterial meningitis. It is clear that the current concepts in the treatment of childhood bacterial meningitis are evolving, and other antibacterial options and possible alternatives such as carbapenems and fluoroquinolones should be considered. Fluid restriction because of the Syndrome of Inappropriate Antidiuretic Hormone Secretion is widely advocated and used. Yet, this practice was recently challenged. It seems that most patients with meningitis do not need fluid restriction. The overwhelming success of the conjugated Hib vaccine and the encouraging results of the new conjugated pneumococcal and meningococcal vaccines suggest that the ideal management of bacterial meningitis is prevention and vaccines development against the most common bacterial agents are the best solution.
急性细菌性脑膜炎仍是全球儿童发病和死亡的重要原因。最近，曾是脑膜炎常见病因的b型流感嗜血杆菌（Hib）在发达国家已几乎消失，这反映出Hib疫苗接种取得了巨大成功。不幸的是，Hib在资源匮乏国家仍是重要病原体。2000年引入的结合型肺炎球菌疫苗可能会带来与Hib疫苗类似的未来趋势。随着肺炎链球菌对青霉素和头孢菌素的耐药性不断演变，万古霉素已成为治疗细菌性脑膜炎的重要抗菌药物。该药物向脑脊液的渗透不可靠令人担忧，而儿科脑膜炎中使用皮质类固醇存在争议，这使情况更加复杂。一些数据表明，在某些情况下，在头孢曲松中添加利福平可能是更好的选择。虽然地塞米松现在被认为是成人肺炎球菌脑膜炎治疗中的标准辅助疗法，但对儿童的益处尚不明确且仍存在争议；因此，尚无明确的儿科推荐。目前正在研究的几种抗炎药物未来可能用作细菌性脑膜炎的辅助疗法。显然，目前儿童细菌性脑膜炎的治疗观念正在演变，应考虑其他抗菌选择以及可能的替代药物，如碳青霉烯类和氟喹诺酮类。因抗利尿激素分泌异常综合征而进行液体限制被广泛提倡和使用。然而，这种做法最近受到了挑战。似乎大多数脑膜炎患者不需要液体限制。结合型Hib疫苗的巨大成功以及新型结合型肺炎球菌和脑膜炎球菌疫苗令人鼓舞的结果表明，细菌性脑膜炎的理想管理是预防，研发针对最常见细菌病原体的疫苗是最佳解决方案。
