Scheld W M, Rocha H, Sande M A, Bryan J P
Am J Med. 1984 Oct 19;77(4C):42-9.
Ceftriaxone is a promising antimicrobial agent in the therapy of bacterial meningitis. The rationale for the clinical evaluation of ceftriaxone in patients with meningitis is based on the following favorable characteristics: ceftriaxone has excellent in vitro activity (MBC90 0.25 microgram/ml or less) against the major meningeal pathogens including meningococci, pneumococci, group B streptococci, Hemophilus influenzae, and Escherichia coli, but it is inactive against Listeria monocytogenes; ceftriaxone is rapidly bactericidal within purulent cerebrospinal fluid in experimental animal models of meningitis induced by pneumococci, group B streptococci, H. influenzae, and E. coli; against most of the major meningeal pathogens, the activity attained in cerebrospinal fluid in human subjects with bacterial meningitis is high (1:512 or greater) and active concentrations of ceftriaxone persist in cerebrospinal fluid for prolonged periods compared with those of other cephalosporins; the results of clinical trials reported to date in patients with meningitis are encouraging. Ceftriaxone deserves further clinical evaluation in the treatment of bacterial meningitis; the optimal dose, frequency of administration, and duration of therapy remain to be determined.
头孢曲松是治疗细菌性脑膜炎的一种有前景的抗菌药物。对脑膜炎患者进行头孢曲松临床评估的依据基于以下有利特性：头孢曲松对包括脑膜炎球菌、肺炎球菌、B组链球菌、流感嗜血杆菌和大肠杆菌在内的主要脑膜病原体具有出色的体外活性（MBC90为0.25微克/毫升或更低），但对单核细胞增生李斯特菌无活性；在肺炎球菌、B组链球菌、流感嗜血杆菌和大肠杆菌诱发的脑膜炎实验动物模型中，头孢曲松在脓性脑脊液中具有快速杀菌作用；对于大多数主要脑膜病原体，细菌性脑膜炎患者脑脊液中达到的活性较高（1:512或更高），与其他头孢菌素相比，头孢曲松的活性浓度在脑脊液中持续较长时间；迄今为止报道的脑膜炎患者临床试验结果令人鼓舞。头孢曲松在细菌性脑膜炎治疗中值得进一步进行临床评估；最佳剂量、给药频率和治疗持续时间仍有待确定。
