Helwig H F
Infection. 1985;13 Suppl 1:S62-7. doi: 10.1007/BF01644221.
Primary meningitis in children is caused by two gram-negative bacterial species, Neisseria meningitidis and Haemophilus influenzae, and one gram-positive bacterial species Streptococcus pneumoniae. Despite optimal penicillin susceptibility, with few exceptions, therapeutic results in pneumococcal meningitis are by far worse than with the other two pathogens. Therefore, and because of the detection of penicillin-resistant rods, the study of alternatives in therapy is justified and was started with cefotaxime. Including six of our own patients, there are reports on 87 patients in the literature suffering from S. pneumoniae meningitis who were treated with cefotaxime monotherapy. Results of these studies will be analyzed. As none of these patients belonged to a prospective controlled study group, final evaluation in comparison with penicillin therapy remains open. There are also several reports on successful treatment of group B streptococcus meningitis with cefotaxime, although there is no need to abandon penicillin therapy. Staphylococcus aureus and Staphylococcus epidermidis meningitis, usually secondary in shunted hydrocephalus, brain tumors, brain injury or other causes, should not be treated with cefotaxime because of its limited activity on these bacteria. Listeria monocytogenes and Streptococcus faecalis are primarily cefotaxime-resistant, and neonatal meningitis of unknown origin, therefore, should not be treated with cefotaxime alone as long as these pathogens cannot be excluded.
儿童原发性脑膜炎由两种革兰氏阴性菌，即脑膜炎奈瑟菌和流感嗜血杆菌，以及一种革兰氏阳性菌肺炎链球菌引起。尽管肺炎链球菌对青霉素的敏感性最佳，但除少数例外情况外，肺炎球菌性脑膜炎的治疗效果远不如另外两种病原体。因此，并且由于检测到对青霉素耐药的菌株，对替代疗法进行研究是合理的，并且从头孢噻肟开始。包括我们自己的6例患者在内，文献中有87例患肺炎链球菌性脑膜炎的患者接受了头孢噻肟单药治疗的报道。将分析这些研究的结果。由于这些患者均不属于前瞻性对照研究组，因此与青霉素治疗相比的最终评估仍未完成。也有几篇关于用头孢噻肟成功治疗B组链球菌性脑膜炎的报道，尽管没有必要放弃青霉素治疗。金黄色葡萄球菌和表皮葡萄球菌性脑膜炎通常继发于分流性脑积水、脑肿瘤、脑损伤或其他原因，由于其对这些细菌的活性有限，不应使用头孢噻肟治疗。单核细胞增生李斯特菌和粪肠球菌主要对头孢噻肟耐药，因此，只要不能排除这些病原体，不明原因的新生儿脑膜炎就不应单独使用头孢噻肟治疗。
