Cherubin C E, Eng R H
Am J Med. 1986 Mar;80(3):398-404. doi: 10.1016/0002-9343(86)90713-8.
Information on 62 bacteriologically confirmed cases of bacterial meningitis treated with cefotaxime in this country was obtained retrospectively from infectious disease consultants. This series of cases differed markedly from the world cumulative case data thus far presented. One of the two most common organisms treated was the pneumococcus (allergy to penicillin or misdiagnosis of the Gram stain results were the major reasons given). The other organism was Klebsiella. Unanticipated bacteriologic successes were noted in two cases of staphylococcal meningitis secondary to parameningeal foci. The bacteriologic cure rate and survival rate were about 85 percent. Failure of monotherapy was seen in one case of Pseudomonas meningitis, as well as in three of five cases of Enterobacter meningitis. In addition, two cases of Escherichia coli meningitis in which moxalactam therapy inexplicably failed were cured with cefotaxime. Close analysis of killing kinetics appeared to explain the Enterobacter and E. coli failures. Thus, overall not all gram-negative species and not all isolates of any particular species that cause meningitis can be successfully treated by cephalosporins. Data obtained during the investigative trials do not appear to be entirely predicative of what occurred during the free clinical use of an antibiotic. Post-investigatory follow-up and surveillance of all newly introduced therapeutic agents are needed.
通过回顾性研究，从传染病顾问处获取了该国62例经细菌学确诊、接受头孢噻肟治疗的细菌性脑膜炎病例信息。这一系列病例与迄今为止公布的全球累积病例数据有显著差异。接受治疗的两种最常见病原体之一是肺炎球菌（对青霉素过敏或革兰氏染色结果误诊是主要原因）。另一种病原体是克雷伯菌。在两例继发于脑膜旁病灶的葡萄球菌性脑膜炎病例中，出现了意外的细菌学治疗成功案例。细菌学治愈率和生存率约为85%。在1例铜绿假单胞菌性脑膜炎以及5例阴沟肠杆菌性脑膜炎中的3例中，单药治疗失败。此外，两例莫名其妙地对羟羧氧酰胺菌素治疗无效的大肠杆菌性脑膜炎，用头孢噻肟治愈。对杀菌动力学的仔细分析似乎可以解释阴沟肠杆菌和大肠杆菌治疗失败的原因。因此，总体而言，并非所有革兰氏阴性菌以及并非所有引起脑膜炎的任何特定菌种的分离株都能通过头孢菌素成功治疗。在研究性试验期间获得的数据似乎并不完全能预测抗生素在临床自由使用期间发生的情况。需要对所有新引入的治疗药物进行研究后的随访和监测。
