Department of Infectious Diseases, Hospital Universitario Central de Asturias, Oviedo University School of Medicine, Celestino Villamil s/n, 33006 Oviedo, Spain.
Int J Antimicrob Agents. 2010 Mar;35(3):301-4. doi: 10.1016/j.ijantimicag.2009.11.012. Epub 2009 Dec 31.
The efficacy of carbapenems versus cefotaxime (8g/day)+metronidazole (1.5-2g/day) [combined standard chemotherapy (CSC)] for the treatment of brain abscess was compared. Fifty-nine adult patients with brain abscesses received either imipenem or meropenem (3-4g/day) or CSC for a mean of 5 weeks, in addition to neurosurgery in most cases. Cure was obtained in 84.7% of cases; 42/47 (89.4%) on carbapenems [18/22 (81.8%) on imipenem versus 24/25 (96.0%) on meropenem] and 8/12 (66.7%) on CSC (P=0.06). Seven patients with multiple abscesses were treated with imipenem (1 died; cure rate 85.7%), five with meropenem (all survived; cure rate 100%) and five with CSC (2 died; cure rate 60%) (P<0.4). Neurosurgery was performed in 43/59 cases (72.9%); 17 (77.3%) in the imipenem group, 21 (84.0%) in the meropenem group and 5 (41.7%) in the CSC group (P=0.02). There was no significant difference in the rate of relapse requiring re-intervention. Treatment with meropenem was associated with a lower mortality than CSC (P=0.026). Seizures were observed only with carbapenems [8/22 (36.4%) for imipenem versus 2/25 (8.0%) for meropenem; P=0.03]. Carbapenems were more effective than CSC for treatment of brain abscesses. Because meropenem induced significantly fewer seizures than imipenem with at least the same clinical efficacy, the former appears to be a better choice to treat this infection.
比较了碳青霉烯类药物与头孢噻肟（8g/天）+甲硝唑（1.5-2g/天）[联合标准化疗（CSC）]治疗脑脓肿的疗效。59 例成人脑脓肿患者除了神经外科手术外，大多数患者还接受了亚胺培南或美罗培南（3-4g/天）或 CSC 治疗，平均 5 周。84.7%的病例获得治愈；47 例碳青霉烯类药物中 42 例（89.4%）[22 例亚胺培南中 18 例（81.8%），25 例美罗培南中 24 例（96.0%）]，12 例 CSC 中 8 例（66.7%）（P=0.06）。7 例多发性脓肿患者接受了亚胺培南治疗（1 例死亡；治愈率 85.7%），5 例接受了美罗培南治疗（全部存活；治愈率 100%），5 例接受了 CSC 治疗（2 例死亡；治愈率 60%）（P<0.4）。43/59 例（72.9%）患者接受了神经外科手术；22 例亚胺培南组中 17 例（77.3%），25 例美罗培南组中 21 例（84.0%），12 例 CSC 组中 5 例（41.7%）（P=0.02）。需要再次干预的复发率无显著差异。美罗培南治疗的死亡率低于 CSC（P=0.026）。只有碳青霉烯类药物才观察到癫痫发作[22 例亚胺培南中 8 例（36.4%），25 例美罗培南中 2 例（8.0%）；P=0.03]。碳青霉烯类药物治疗脑脓肿的疗效优于 CSC。由于美罗培南引起的癫痫发作明显少于亚胺培南，且具有相同的临床疗效，因此前者似乎是治疗这种感染的更好选择。
