Kobayashi Y
Jpn J Antibiot. 1975 Aug;28(4):567-80.
Purulent meningitis in patients admitted to the pediatric department of Kyoto University Hospital and affiliated institutions from 1951 through 1973 were studied with emphasis on the kinds of the causative organisms and the susceptibility of these organisms to antibiotics. The findings in this study have served to help select antibiotics most likely to be effective against this disease. The overall incidence of purulent meningitis was 0.68%. This figure decreased little throughout the period. As for the frequency of causative organisms, Neisseria meningitidis led the list, and Diplococcus pneumoniae ranked just behind. Haemophilus influenzae was rare. The frequency of N. meningitidis, however, decreased sharply in spite of the essentially unchanged overall incidence of this disease. The probable reason for the poor prognosis of this disease in spite of the remarkable strides in chemotherapy is the decreased frequency of N. meningitidis and the inversely increased organisms that are resistant to usual chemotherapy. The therapeutic effectiveness of cefazolin against this disease was studied in 15 children including eight newborns and four infants. The daily per kg bodyweight dose was 50 mg or less in four, 50 approximately 100 mg in five, and more than 100 mg in the remaining six. The route of administration was either intramuscular or intravenous. No deaths occurred. The rate of effectiveness was as high as 80%. Residual symptoms were recorded in six and, in as many as five of them, the cause was a-tributable to the delayed detection of the disease. Neither side effects nor aberrent laboratory findings attributable to large doses of cefazolin were recorded. Diffusibility of cefazolin into the CSF was studied in nine subjects. The CSF concentration of this antibiotic was shown to be somewhat lower than that of ampicillin or cephaloridine and to account on an average for 13% of the mean peak serum level. This relatively low diffusibility will be offset by its high serum concentration and safe large-dose therapy. These findings have clearly shown that the therapeutic effectiveness of cefazolin is as high as that of ampicillin, and that this excellent effectiveness holds true even when the causative organism happens to be Escherichia coli, Klebsiella, etc. that are resistant to ampicillin. The authors have furthermore scrutinized much literature on the frequency of the causative organisms, emergence of resistant strains, and the diffusibility of antibiotics into the CSF, and arrived at the conclusion that cefazolin is a promising antibiotic of choice for the treatment of purulent meningitis in newborn. The daily dose is preferably 150 mg/kg or more given in three divided intravenous doses. Meanwhile ampicillin proved to be useful as the antibiotic of choice for the treatment of purulent meningitis in infants and children.
对1951年至1973年期间入住京都大学医院儿科及附属医院的化脓性脑膜炎患者进行了研究，重点关注病原体种类及其对抗生素的敏感性。本研究结果有助于选择最有可能有效治疗该疾病的抗生素。化脓性脑膜炎的总体发病率为0.68%。在此期间，这一数字几乎没有下降。至于病原体的出现频率，脑膜炎奈瑟菌位居榜首，肺炎双球菌紧随其后。流感嗜血杆菌较为罕见。然而，尽管该疾病的总体发病率基本保持不变，但脑膜炎奈瑟菌的出现频率却急剧下降。尽管化疗取得了显著进展，但该疾病预后不佳的可能原因是脑膜炎奈瑟菌的频率降低，以及对常规化疗耐药的病原体数量反而增加。对15名儿童（包括8名新生儿和4名婴儿）研究了头孢唑林对该疾病的治疗效果。每千克体重每日剂量在4名儿童中为50毫克或更低，5名儿童中为约50至100毫克，其余6名儿童中超过100毫克。给药途径为肌肉注射或静脉注射。无死亡病例发生。有效率高达80%。有6例记录了残留症状，其中多达5例的原因可归因于疾病检测延迟。未记录到因大剂量头孢唑林引起的副作用或异常实验室检查结果。对9名受试者研究了头孢唑林在脑脊液中的扩散情况。结果显示，这种抗生素在脑脊液中的浓度略低于氨苄西林或头孢菌素，平均占血清平均峰值水平的13%。这种相对较低的扩散性将被其高血清浓度和安全的大剂量治疗所抵消。这些发现清楚地表明，头孢唑林的治疗效果与氨苄西林一样高，即使病原体碰巧是对氨苄西林耐药的大肠杆菌、克雷伯菌等，这种优异的效果依然成立。作者还仔细研究了大量关于病原体出现频率、耐药菌株的出现以及抗生素在脑脊液中的扩散情况的文献，并得出结论，头孢唑林是治疗新生儿化脓性脑膜炎的一种有前景的首选抗生素。每日剂量最好为150毫克/千克或更高，分三次静脉注射。同时，氨苄西林被证明是治疗婴幼儿化脓性脑膜炎的首选抗生素。
