Jacobs R F, Kearns G L
University of Arkansas for Medical Sciences, Little Rock.
Infection. 1989 Sep-Oct;17(5):338-42. doi: 10.1007/BF01650725.
Pharmacokinetic studies on cefotaxime/desacetylcefotaxime were carried out in very low birth weight newborns (n = 18; 500-1500 g; 28.4 +/- 2.4 weeks gestational age) during the first week of life. We have previously reported that the elimination t 1/2 of cefotaxime (3.4-6.4 h) and desacetylcefotaxime (9.4 h) was longer than previously described in term infants and children. In very low birth weight neonates, a single 50 mg/kg daily dose of cefotaxime may produce accumulation of the metabolite desacetylcefotaxime in serum. In a non-comparative prospective clinical trail, 22 infants (one week - three months) were treated for gram-negative enteric bacillary meningitis with cefotaxime at a dosage of 50 mg/kg/day. The predominant pathogen was Escherichia coli in 14 cases and Enterobacter cloacae in four cases. Cultures of the cerebrospinal fluid obtained 24-48 h after the initiation of treatment were sterile in all subjects. Survival and complication rates of 95% and 19%, respectively, were observed. This compared favorably to previously published experiences with alternative treatment regimens for neonatal gram-negative enteric meningitis. In both the pharmacokinetic and meningitis studies, the safety profile for cefotaxime was excellent with no adverse reactions.
在出生体重极低的新生儿（n = 18；体重500 - 1500克；胎龄28.4 +/- 2.4周）出生后的第一周内，开展了头孢噻肟/去乙酰头孢噻肟的药代动力学研究。我们之前曾报告，头孢噻肟（3.4 - 6.4小时）和去乙酰头孢噻肟（9.4小时）的消除半衰期比之前在足月儿和儿童中所描述的更长。在出生体重极低的新生儿中，每日单次给予50毫克/千克剂量的头孢噻肟可能会导致代谢产物去乙酰头孢噻肟在血清中蓄积。在一项非对照前瞻性临床试验中，22名婴儿（1周 - 3个月）因革兰氏阴性肠道杆菌性脑膜炎接受了50毫克/千克/天剂量的头孢噻肟治疗。主要病原体为大肠杆菌（14例）和阴沟肠杆菌（4例）。在开始治疗后24 - 48小时采集的脑脊液培养物在所有受试者中均无菌。观察到的存活率和并发症发生率分别为95%和19%。这与之前发表的关于新生儿革兰氏阴性肠道脑膜炎替代治疗方案的经验相比更具优势。在药代动力学研究和脑膜炎研究中，头孢噻肟的安全性均极佳，未出现不良反应。
