Klugman K P, Dagan R
Department of Medical Microbiology, South African Institute for Medical Research, Johannesburg.
Scand J Infect Dis Suppl. 1995;96:45-8.
The carbapenem class of antibacterial agents is highly effective in vitro against the bacterial pathogens causing meningitis. Both imipenem and meropenem penetrate into the cerebrospinal fluid of children with inflamed meninges in the acute phase of meningitis. The wider clinical use of imipenem/cilastatin for the treatment of meningitis has been limited by the high incidence of seizures (up to 33%) in patients not having seizures prior to drug therapy. However, imipenem/cilastatin has been successfully used for the treatment of pneumococcal meningitis following failure of treatment with third-generation cephalosporins. The bacteriological and clinical efficacy of meropenem appears similar to that of cefotaxime in the management of meningitis in children and there was no significant propensity of either meropenem or cefotaxime to cause seizures. Meropenem has also been usefully employed to treat multi-resistant Pseudomonas aeruginosa meningitis. These data suggest that meropenem should be further investigated for use in the treatment of meningitis.
碳青霉烯类抗菌药物在体外对引起脑膜炎的细菌病原体具有高效性。亚胺培南和美罗培南都能在脑膜炎急性期穿透进入患有炎症性脑膜的儿童的脑脊液中。亚胺培南/西司他丁在治疗脑膜炎方面更广泛的临床应用受到药物治疗前无癫痫发作患者中癫痫发作高发生率（高达33%）的限制。然而，在第三代头孢菌素治疗失败后，亚胺培南/西司他丁已成功用于治疗肺炎球菌性脑膜炎。在儿童脑膜炎的治疗中，美罗培南的细菌学和临床疗效似乎与头孢噻肟相似，美罗培南或头孢噻肟均无明显的癫痫发作倾向。美罗培南也已有效地用于治疗多重耐药铜绿假单胞菌脑膜炎。这些数据表明，美罗培南在治疗脑膜炎方面应进一步进行研究。
