Lebel M H, Hoyt M J, McCracken G H
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas.
J Pediatr. 1989 Jun;114(6):1049-54. doi: 10.1016/s0022-3476(89)80462-7.
To assess the comparative efficacy of cefuroxime and ceftriaxone for the treatment of bacterial meningitis, we reviewed the records from four prospective efficacy trials conducted at our institution. One hundred seventy-four infants and children received ceftriaxone and 159 received cefuroxime. The clinical characteristics of the two groups were comparable at admission. After 24 hours of therapy, routine cerebrospinal fluid cultures for all patients treated with ceftriaxone were sterile, whereas 9% of cerebrospinal fluid cultures were positive in cefuroxime-treated patients (p less than 0.001). More cefuroxime-treated patients had abnormal physical examinations at the time of discharge than did ceftriaxone-treated patients (39/159 vs 25/174, p = 0.02). At 6-week and 1-year follow-up examinations, there was no longer a statistically significant difference in the incidence of neurologic abnormalities between the two therapy groups, but the incidence of hearing impairment in one or both ears was higher in the cefuroxime (18%) than in the ceftriaxone (11%) treatment group. Both regimens are efficacious for the treatment of bacterial meningitis, but some patients may not respond as satisfactorily to cefuroxime as to ceftriaxone.
为评估头孢呋辛和头孢曲松治疗细菌性脑膜炎的相对疗效，我们回顾了在本机构进行的四项前瞻性疗效试验的记录。174名婴幼儿和儿童接受了头孢曲松治疗，159名接受了头孢呋辛治疗。两组患者入院时的临床特征具有可比性。治疗24小时后，所有接受头孢曲松治疗的患者的常规脑脊液培养均无菌，而接受头孢呋辛治疗的患者中9%的脑脊液培养呈阳性（p<0.001）。出院时，接受头孢呋辛治疗的患者中有更多患者体检结果异常，高于接受头孢曲松治疗的患者（39/159 vs 25/174，p = 0.02）。在6周和1年的随访检查中，两组治疗组之间神经功能异常的发生率不再有统计学上的显著差异，但头孢呋辛治疗组单耳或双耳听力障碍的发生率（18%）高于头孢曲松治疗组（11%）。两种治疗方案对细菌性脑膜炎均有效，但部分患者对头孢呋辛的反应可能不如对头孢曲松那样令人满意。
