Taillebois L, Astruc J
Clinique des Maladies Infectieuses B (Enfants), Centre Gui de Chauliac, Montpellier.
Ann Pediatr (Paris). 1991 Oct;38(8):531-6.
The initial treatment of infantile and childhood bacterial meningitis is now well standardized, but three current aspects are discussed in this paper. Although classically, ampicillin can still be given as the initial treatment of bacterial meningitis in children, current epidemiologic data demonstrate the emergence of resistant strains of Haemophilus and Pneumococcus, and consequently use of a third-generation cephalosporin should be preferred. Concerning duration of treatment, 4 to 5 days seem adequate for meningococci and 7 days for Haemophilus influenzae and pneumococci. Lastly, the usefulness of adjunctive antiinflammatory treatment is considered. The purpose of this treatment is to lower the risk of cerebral complications and neurosensory impairment. Current data suggest that use of corticosteroids as early as possible may be helpful. Improved understanding of the pathophysiology of pediatric bacterial meningitis has led to other forms of treatment being proposed, but their value remains to be proven.
婴幼儿及儿童细菌性脑膜炎的初始治疗目前已得到很好的规范，但本文讨论了当前的三个方面。传统上，氨苄西林仍可作为儿童细菌性脑膜炎的初始治疗药物，但目前的流行病学数据显示，嗜血杆菌和肺炎球菌耐药菌株的出现，因此应优先使用第三代头孢菌素。关于治疗持续时间，脑膜炎球菌感染4至5天似乎足够，流感嗜血杆菌和肺炎球菌感染则为7天。最后，考虑辅助抗炎治疗的作用。这种治疗的目的是降低脑部并发症和神经感觉障碍的风险。目前的数据表明，尽早使用皮质类固醇可能会有帮助。对小儿细菌性脑膜炎病理生理学的进一步了解促使人们提出了其他治疗形式，但其价值仍有待证实。
