Lapointe J R, Béliveau C, Chicoine L, Joncas J H
J Antimicrob Chemother. 1984 Sep;14 Suppl B:167-80. doi: 10.1093/jac/14.suppl_b.167.
Ampicillin-cefotaxime was tested as initial therapy of presumptive bacterial meningitis in 55 children greater than or equal to 2 months of age at our hospital. During the first year of this ongoing trial, 11 patients, 10 whose CSF yielded ampicillin-resistant Haemophilus influenzae type b (MIC greater than 16 mg/l, beta-lactamase +) and one, indole-negative proteus (MIC 4 mg/l), were begun on ampicillin-cefotaxime and then continued on cefotaxime alone. All did well clinically except one who convulsed briefly but recovered without sequelae. The cefotaxime MICs/MBCs of the beta-lactamase-positive H. influenzae isolates (less than or equal to 0.007 to 0.03/less than or equal to 0.007 to 0.12) and the proteus isolate (0.03/0.12) were significantly lower than chloramphenicol MICs/MBCs (0.25 to 1.0/0.5 to 1.0 and 8/greater than 16). We followed 44 other children with meningitis due to ampicillin-sensitive organisms who were treated with ampicillin or penicillin after 1 or 2 days of ampicillin-cefotaxime. Aetiological agents included ampicillin-sensitive H. influenzae (25), pneumococci (9), meningococci (8), Strept. MG (1) and Listeria monocytogenes (1). 40/44 recovered uneventfully. There were 4 neurological complications: the streptococcal meningitis sustained a brain abscess and the three others were motor incoordination (sensitive haemophilus), hearing loss and subdural effusion (2 pneumococci). There were no deaths. 18/48 children managed initially with ampicillin-chloramphenicol during the same 12-month period one year earlier had significant neurological complications and/or sequelae and there was one death; aetiological agents included sensitive H. influenzae (30), pneumococci (9), ampicillin-resistant haemophilus (5), meningococci (3) and pneumococci plus strept. MG (1). The two groups were comparable except for the number of resistant haemophilus and meningococcal strains and underlying disease more frequent in the ampicillin-cefotaxime group. A significant reduction of neurological morbidity (5/55 or 9.1% vs. 18/48 or 37.5%:P less than 0.001) was therefore associated with the ampicillin-cefotaxime schedule in the initial treatment of proven bacterial meningitis. A prolonged hospitalization (greater than 15 days) was less frequent (P less than 0.01) in the ampicillin-cefotaxime group (3/55 or 5.5% vs. 13/48 or 27.1%). The results of the trial to date are considered to be very promising.
在我院，对55例年龄大于或等于2个月的儿童，用氨苄西林-头孢噻肟作为推测性细菌性脑膜炎的初始治疗方法进行了试验。在这项正在进行的试验的第一年，11例患者开始接受氨苄西林-头孢噻肟治疗，之后仅继续使用头孢噻肟，其中10例脑脊液培养出对氨苄西林耐药的b型流感嗜血杆菌（MIC大于16mg/L，β-内酰胺酶阳性），1例为吲哚阴性变形杆菌（MIC 4mg/L）。除1例短暂惊厥但未留后遗症外，所有患者临床情况良好。β-内酰胺酶阳性的流感嗜血杆菌分离株（小于或等于0.007至0.03/小于或等于0.007至0.12）和变形杆菌分离株（0.03/0.12）的头孢噻肟MICs/MBCs显著低于氯霉素的MICs/MBCs（0.25至1.0/0.5至1.0和8/大于16）。我们随访了另外44例因对氨苄西林敏感的病原体引起脑膜炎的儿童，他们在接受1或2天的氨苄西林-头孢噻肟治疗后，改用氨苄西林或青霉素治疗。病原体包括对氨苄西林敏感的流感嗜血杆菌（25例）、肺炎球菌（9例）、脑膜炎球菌（8例）、无乳链球菌（1例）和单核细胞增生李斯特菌（1例）。44例中有40例康复顺利。有4例神经并发症：链球菌性脑膜炎并发脑脓肿，另外3例分别为运动不协调（流感嗜血杆菌敏感株）、听力丧失和硬膜下积液（2例肺炎球菌）。无死亡病例。在一年前同一12个月期间，最初用氨苄西林-氯霉素治疗的48例儿童中有18例有明显的神经并发症和/或后遗症，并有1例死亡；病原体包括敏感的流感嗜血杆菌（30例）、肺炎球菌（9例）、对氨苄西林耐药的嗜血杆菌（5例）、脑膜炎球菌（3例）以及肺炎球菌加无乳链球菌（1例）。除了耐药嗜血杆菌和脑膜炎球菌菌株数量以及潜在疾病在氨苄西林-头孢噻肟组中更常见外，两组具有可比性。因此，在确诊的细菌性脑膜炎的初始治疗中，氨苄西林-头孢噻肟方案与神经疾病发病率的显著降低相关（5/55或9.1%对18/48或37.5%：P小于0.001）。氨苄西林-头孢噻肟组住院时间延长（大于15天）的情况较少（P小于0.01）（3/55或5.5%对13/48或27.1%）。迄今为止，该试验的结果被认为非常有前景。
