Ampel N M, Labadie E L
West J Med. 1987 Sep;147(3):309-13.
Over the past six years, many new agents have become available for the treatment of bacterial central nervous system (CNS) infections. Certain principles guide the use of these agents for CNS infections: first, an antimicrobial agent must be able to penetrate the CNS to be effective; second, the CNS is a "relatively immunoincompetent site" so that an antimicrobial must achieve levels within the CNS capable of killing the offending bacterium. The lack of efficacy of chloramphenicol for meningitis due to gram-negative aerobes is probably due to its failure to achieve such killing levels, whereas the success of the newer cephalosporins, such as cefotaxime and ceftriaxone, is due to their very high killing activity against these organisms. Penicillin remains the first choice for pneumococcal and meningococcal meningitis. Ampicillin plus chloramphenicol is still recommended as initial therapy for meningitis due to Hemophilus influenzae. The newer cephalosporins are now the first choice for the treatment of meningitis due to many gram-negative bacilli. Trimethoprim-sulfamethoxazole may also be useful in some of these infections and those due to Listeria monocytogenes. In the treatment of severe CNS infections, a team approach is advised to ensure optimal therapy.
在过去六年中，出现了许多可用于治疗细菌性中枢神经系统（CNS）感染的新型药物。使用这些药物治疗CNS感染遵循某些原则：首先，抗菌药物必须能够穿透中枢神经系统才能发挥作用；其次，中枢神经系统是一个“相对免疫功能不全的部位”，因此抗菌药物必须在中枢神经系统内达到能够杀死致病细菌的浓度。氯霉素对革兰氏阴性需氧菌引起的脑膜炎无效，可能是因为它未能达到这样的杀菌浓度，而新型头孢菌素，如头孢噻肟和头孢曲松的成功，是由于它们对这些细菌具有非常高的杀菌活性。青霉素仍然是肺炎球菌和脑膜炎球菌性脑膜炎的首选药物。氨苄西林加氯霉素仍被推荐作为流感嗜血杆菌引起的脑膜炎的初始治疗方案。新型头孢菌素现在是许多革兰氏阴性杆菌引起的脑膜炎的首选治疗药物。甲氧苄啶-磺胺甲恶唑在其中一些感染以及单核细胞增生李斯特菌引起的感染中可能也有用。在治疗严重的中枢神经系统感染时，建议采用团队协作的方法以确保最佳治疗效果。
