Guggenbichler J P
Padiatr Padol. 1982;17(1):43-65.
In the years 1970 to 1979 312 patients with purulent meningitis were treated at the University of Innsbruck, Department of Pediatrics. The overall fatality rate was 16%, the majority of fatal cases were due to gram negative organisms before 1977. The mortality rate of meningococcal meningitis due to H. influenzae was 5.6 and 1.6%, respectively and compares very well to reports in the literature. 12% of children are severely handicapped. Hearing impairment is the most frequent cause of retardation with 6.8%. We compared therapeutic results of two different treatment regimen in our clinic with the therapeutic results in other centers reported in the literature. The combination of ampicillin and chloramphenicol was superior to other treatment modalities particularly ampicillin monotherapy in H. influenzae meningitis and meningitis due to unknown organisms. Theoretical reservations against this combination have been eliminated by the proof of the bactericidal action of chloramphenicol against the most common meningeal pathogens and the synergistic action with beta lactam antibiotics. In pneumococcal meningitis the administration of high doses of Na-Penicillin G as i. v. bolus proved to be connected with unexpected complications and fatalities. The administration of 25000-40000 E Na Penicillin G as an i. v. infusion over 1 hour 4--6 times daily was a less hazardous yet effective therapy. Unsatisfying results in the treatment of gram negative meningitis in neonates prompted the investigation of a new compound fosfomycin for this indication. In vitro investigation of the antimicrobial activity against 68 meningeal pathogens and investigation of this drug in a lapine model showed encouraging results. In the last years a limited clinical trial in severely affected newborn infants was done with promising therapeutic efficacy. A larger scale investigation of this drug is now proceeding in form of a National cooperative Study of gram negative meningitis in Austria. Besides an effective antimicrobial treatment particular attention has to be paid to an adequate fluid and electrolyte replacement. Symptomatic therapy of complications e. g. seizures as well as continuous close monitoring of all vital signs is mandatory for optimal therapeutic success. Subdural effusions have been observed infrequently and only diagnostic subdural punctures have been performed.
1970年至1979年期间，因斯布鲁克大学儿科收治了312例化脓性脑膜炎患者。总体死亡率为16%，1977年以前大多数死亡病例是由革兰氏阴性菌引起的。由流感嗜血杆菌引起的脑膜炎球菌性脑膜炎的死亡率分别为5.6%和1.6%，与文献报道相比情况良好。12%的儿童有严重残疾。听力障碍是导致发育迟缓最常见的原因，占6.8%。我们将本诊所两种不同治疗方案的治疗结果与文献中其他中心报道的治疗结果进行了比较。氨苄西林和氯霉素联合用药优于其他治疗方式，尤其是在流感嗜血杆菌性脑膜炎和病因不明的脑膜炎中，氨苄西林单药治疗效果不佳。氯霉素对最常见的脑膜病原体具有杀菌作用，并与β-内酰胺类抗生素具有协同作用，消除了对这种联合用药的理论顾虑。在肺炎球菌性脑膜炎中，静脉推注大剂量青霉素G钠被证明会引发意外并发症和死亡。每日4至6次，将25000 - 40000单位青霉素G钠静脉输注1小时是一种危害较小但有效的治疗方法。新生儿革兰氏阴性菌脑膜炎治疗效果不理想，促使人们对一种新化合物磷霉素用于该适应症进行研究。对68种脑膜病原体的抗菌活性进行的体外研究以及在兔模型中对该药物的研究显示了令人鼓舞的结果。近年来，在病情严重的新生儿中进行了有限的临床试验，治疗效果良好。目前，奥地利正在以全国性革兰氏阴性菌脑膜炎合作研究的形式对该药物进行更大规模的研究。除了有效的抗菌治疗外，还必须特别注意适当补充液体和电解质。对于并发症（如癫痫发作）进行对症治疗以及持续密切监测所有生命体征，对于取得最佳治疗效果至关重要。硬膜下积液很少见，仅进行了诊断性硬膜下穿刺。
