Kaplan S L
Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston.
Scand J Infect Dis Suppl. 1990;73:43-54.
Despite timely and appropriate antimicrobial therapy of bacterial meningitis, neurologic sequelae still occur in some children. This also remains true for the third generation cephalosporins such as ceftriaxone and cefotaxime despite their extraordinary high bactericidal titers in the cerebrospinal fluid of children with bacterial meningitis. The most effective way to prevent neurologic damage in these patients is to prevent the infection from developing in the first place. This may be achievable in the very near future for meningitis due to Haemophilus influenzae type b, the most common organism causing meningitis in children in many parts of the world. Unfortunately, even though such means of prevention may be available or under development, ensuring that all children receive these immunizations is very difficult to accomplish. Furthermore, some forms of bacterial meningitis are not likely to be preventable by immunization or other methods and thus efforts to develop new means to minimize the neurologic damage due to meningitis remain important. One such effort involves the use of antiinflammatory agents in addition to antimicrobial therapy for the treatment of this infection. This review will focus on the role of one such antiinflammatory agent, corticosteroids, as adjunctive therapy for bacterial meningitis.
尽管对细菌性脑膜炎进行了及时且恰当的抗菌治疗，但仍有一些儿童会出现神经后遗症。对于第三代头孢菌素，如头孢曲松和头孢噻肟来说也是如此，尽管它们在患细菌性脑膜炎儿童的脑脊液中具有极高的杀菌效价。预防这些患者神经损伤的最有效方法是从一开始就预防感染的发生。对于由b型流感嗜血杆菌引起的脑膜炎，这在不久的将来或许可以实现，b型流感嗜血杆菌是世界许多地区儿童脑膜炎最常见的病原体。不幸的是，即便可能有此类预防手段或正在研发之中，但要确保所有儿童都接种这些疫苗却很难做到。此外，某些形式的细菌性脑膜炎不太可能通过免疫接种或其他方法预防，因此，研发新方法以尽量减少脑膜炎所致神经损伤的努力仍然很重要。其中一项努力是在抗菌治疗的基础上，加用抗炎药物来治疗这种感染。本综述将聚焦于一种此类抗炎药物——皮质类固醇作为细菌性脑膜炎辅助治疗的作用。
