MMWR Morb Mortal Wkly Rep. 2016 Jan 1;64(50-51):1375-7. doi: 10.15585/mmwr.mm6450a2.
The burden of disease from bacterial meningitis is highest in low-income countries (1). Early initiation of antibiotic therapy is important in reducing the risk for mortality. Current treatment guidelines recommend the use of an expanded-spectrum cephalosporin (cefotaxime or ceftriaxone) (2), but these therapies increasingly are limited by drug resistance, and are threatened by the proliferation of substandard and falsified medicines (3,4). In February 2013, a case of bacterial meningitis following a middle ear infection was diagnosed in an adolescent at the Mulago National Referral Hospital in Kampala, Uganda. Once-daily treatment with 2 g of intravenous ceftriaxone administered according to guidelines failed, and the patient died. To determine whether the patient's treatment failure and subsequent death might be related to the ceftriaxone product administered, a sealed vial similar to the one administered to the patient was analyzed at the University of Ottawa, Canada, and was found to contain only 0.455 g of the drug, not 1 g as stated by the manufacturer. This would have resulted in subtherapeutic dosing. Substandard medicines are a global problem that disproportionately affects low-income countries, leading to fatal consequences and promoting the emergence of drug resistance (4).
细菌性脑膜炎的疾病负担在低收入国家最高。早期开始抗生素治疗对于降低死亡率很重要。目前的治疗指南建议使用广谱头孢菌素（头孢噻肟或头孢曲松）（2），但这些治疗方法越来越受到耐药性的限制，并受到劣药和假药的泛滥的威胁（3,4）。2013 年 2 月，在乌干达坎帕拉的穆拉戈国家转诊医院，一名青少年因中耳感染导致细菌性脑膜炎被诊断出。根据指南，每天一次静脉注射 2 克头孢曲松的治疗失败，患者死亡。为了确定患者的治疗失败和随后的死亡是否与所给予的头孢曲松产品有关，加拿大渥太华大学对类似于给予患者的密封小瓶进行了分析，结果发现小瓶中仅含有 0.455 克药物，而不是制造商所声称的 1 克。这将导致治疗剂量不足。劣药是一个全球性问题，在低收入国家的影响不成比例，导致致命后果并促进耐药性的出现（4）。
