Gilbert V E, Beals J D, Natelson S E, Tyler W A
Neurosurgery. 1986 Apr;18(4):402-6. doi: 10.1227/00006123-198604000-00002.
Six patients with cerebrospinal fluid (CSF) leaks and gram-negative bacillary meningitis (GNBM) were treated with large doses of intrathecal amikacin (20 to 40 mg daily) and systemic antibiotics. Bactericidal activity was measured in the CSF of each patient, and the dose of intrathecal amikacin was increased if bactericidal activity was absent. Five of six patients had no bactericidal activity with systemic antibiotics alone and/or low dose intrathecal amikacin. All six patients were cured, and three of four patients with vertebral lesions had cessation of CSF leaks within 72 hours of the start of intrathecal amikacin. Intrathecal treatment for 7 to 10 days was adequate for five patients; the CSF of all patients was sterile within 72 hours, and all had a 90% reduction of pleocytosis in the CSF within 96 hours. One patient had radicular back pain after each intrathecal injection, but other side effects were not observed. These findings indicate that CSF leaks associated with GNBM can be effectively treated with large doses of intrathecal amikacin plus systemic antibiotics.
六例脑脊液（CSF）漏合并革兰氏阴性杆菌性脑膜炎（GNBM）患者接受了大剂量鞘内注射阿米卡星（每日20至40毫克）及全身使用抗生素治疗。对每位患者的脑脊液进行杀菌活性检测，若未检测到杀菌活性，则增加鞘内注射阿米卡星的剂量。六例患者中有五例仅使用全身抗生素和/或低剂量鞘内注射阿米卡星时未表现出杀菌活性。所有六例患者均治愈，四例有椎体病变的患者中有三例在开始鞘内注射阿米卡星72小时内脑脊液漏停止。五例患者鞘内治疗7至10天足够；所有患者的脑脊液在72小时内无菌，且所有患者在96小时内脑脊液中细胞增多症减少90%。一名患者每次鞘内注射后出现神经根性背痛，但未观察到其他副作用。这些发现表明，大剂量鞘内注射阿米卡星加全身抗生素可有效治疗与GNBM相关的脑脊液漏。
