Schwartz B
Department of Pediatrics, Emory University, Atlanta, Georgia 30303.
Rev Infect Dis. 1991 Jan-Feb;13 Suppl 2:S170-3. doi: 10.1093/clinids/13.supplement_2.s170.
Chemoprophylaxis with antibiotics is both feasible and desirable for prevention of a potentially serious disease when specific groups at risk can be defined and when a safe, effective, and affordable prophylactic agent is available. Although the Advisory Committee on Immunization Practices recommends rifampin for prophylaxis of meningococcal disease, there are failures of treatment and adverse reactions associated with the administration of this drug, and it cannot be used during pregnancy. In 1987, during an outbreak of group A meningococcal disease in Saudi Arabia, the efficacy of a single intramuscular dose of ceftriaxone was compared with the standard regimen of rifampin for eradication of pharyngeal carriage of Neisseria meningitidis among persons at risk. Follow-up cultures indicated successful eradication for 97% of those who received ceftriaxone and 75% of those who received rifampin. Thus, although ceftriaxone exceeds rifampin in fulfilling the criteria for an effective prophylactic agent, recommendations regarding its use still must be made with caution because of limited clinical experience.
当能够确定特定的高危人群，并且有安全、有效且可负担得起的预防药物时，使用抗生素进行化学预防对于预防一种潜在的严重疾病是可行且可取的。尽管免疫实践咨询委员会推荐利福平用于预防脑膜炎球菌病，但使用这种药物存在治疗失败和不良反应，并且不能在孕期使用。1987年，在沙特阿拉伯A群脑膜炎球菌病暴发期间，将单剂量肌内注射头孢曲松的疗效与利福平的标准治疗方案进行比较，以根除高危人群中脑膜炎奈瑟菌的咽部携带情况。随访培养显示，接受头孢曲松治疗的人中有97%成功根除，接受利福平治疗的人中有75%成功根除。因此，尽管头孢曲松在满足有效预防药物的标准方面超过了利福平，但由于临床经验有限，关于其使用的建议仍必须谨慎做出。
