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[新生儿和儿童细菌性脑膜炎的治疗]

[Treatment of bacterial meningitis in newborn infants and children].

作者信息

Aujard Y, Bedu A, Baumann C, Bingen E

机构信息

Service de néonatalogie, Hôpital Robert-Debré, Paris.

出版信息

Rev Prat. 1994 Oct 15;44(16):2157-62.

PMID:7984914
Abstract

Third generation cephalosporin as cefotaxime or ceftriaxone is the best first line treatment. Duration of treatment is 7 to 10 days in uncomplicated disease. Dexamethasone used very early--before or at the same time of the antibiotic injection--seems to decrease sensorial sequelae. Amikacin by IV route, decreases short term complications. For bacterial meningitis due to intermediate penicillin pneumococci, an increase in daily dose of beta-lactamin is recommended; for resistant pneumococci, vancomycin by continuous infusion and with large doses is used. Chemoprophylaxis by rifampicine is effective for both Meningococcus and Haemophilus. Haemophilus influenzae b vaccination will decrease systemic infection due to this pathogen. In newborns, morbidity is higher, due in part to brain abscesses. Therapeutic choice is not the same for materno-foetal and postnatal infection. Antibiotherapy duration is, at least, 15 days and 21 days for gram-negative bacteria.

摘要

第三代头孢菌素如头孢噻肟或头孢曲松是最佳的一线治疗药物。对于非复杂性疾病,治疗疗程为7至10天。在抗生素注射前或同时尽早使用地塞米松似乎可减少感觉后遗症。静脉注射阿米卡星可减少短期并发症。对于由中度青霉素敏感性肺炎球菌引起的细菌性脑膜炎,建议增加β-内酰胺类药物的日剂量;对于耐药肺炎球菌,采用持续输注大剂量万古霉素治疗。利福平进行化学预防对脑膜炎球菌和嗜血杆菌均有效。b型流感嗜血杆菌疫苗接种可减少该病原体引起的全身感染。在新生儿中,发病率较高,部分原因是脑脓肿。母婴感染和产后感染的治疗选择不同。对于革兰氏阴性菌感染,抗生素治疗疗程至少为15天和21天。

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