Guggenbichler J P, Allerberger F, Dietze O, Klima G
Universitäts-Kinderklinik, Innsbruck.
Padiatr Padol. 1989;24(1):3-19.
Treatment of bacterial meningitis in children requires the choice of the optimal antimicrobial substance: besides the in vitro susceptibility also pharmacokinetic parameters (CSF penetration and elimination) have to be considered. A careful medical history and a few laboratory tests (gram-stain and antigen determination) provide a preliminary bacterial diagnosis within less than one hour. In addition to the identification of the causative organism also the determination of the number of colony forming units per milliliter CSF is of crucial importance. A rapid bacterial cell kill of high numbers of pneumococci, meningococci and streptococci group B overwhelms the CSF with endotoxins with rapidly increasing cerebral edema. Applying a slowly increasing dosage regimen proved effective in preventing this detrimental effects. Supportive therapy e.g. treatment of septic shock, disseminated intravascular coagulation, cerebral edema and anticonvulsive therapy is of paramount importance. Inadequate ADH secretion in the majority of patients requires a restricted fluid and electrolyte supplementation. By this combined therapeutic approach a remarkable low lethality rate and a low number of patients with late sequelae was seen.
除了体外药敏试验外，还必须考虑药代动力学参数（脑脊液穿透率和清除率）。详细的病史和一些实验室检查（革兰氏染色和抗原测定）可在不到一小时内做出初步细菌诊断。除了鉴定病原体，每毫升脑脊液中菌落形成单位数量的测定也至关重要。大量肺炎球菌、脑膜炎球菌和B组链球菌的快速细菌杀灭会使脑脊液中内毒素激增，迅速加重脑水肿。采用缓慢增加剂量的方案被证明对预防这种有害影响有效。支持性治疗，如感染性休克、弥散性血管内凝血、脑水肿的治疗以及抗惊厥治疗至关重要。大多数患者抗利尿激素分泌不足，需要限制液体和电解质补充。通过这种综合治疗方法，病死率显著降低，后遗症患者数量也较少。
