Akpede O, Abiodun P O, Sykes M, Salami C E
Department of Child Health, University of Benin Teaching Hospital, Nigeria.
East Afr Med J. 1994 Jan;71(1):14-20.
Of 253 culture proven cases of bacterial meningitis in infants aged over a month and children up to one year old in Benin City, Nigeria, from 1985-1990, 49.8% were due to N. meningitidis, 21.4% S. pneumoniae, 15.4% H. influenzae and 13.4% other organisms, including S. aureus and enterobacteriaceae. Compared to the period 1974-1984 in Southern Nigeria, N. meningitidis has replaced S. pneumoniae as the commonest organism. N. meningitidis was relatively infrequent below two years of age while H. influenzae was rare after five years. Approximately half of isolates of S. aureus and enterobacteriaceae were in infants aged six months or less. The proportions of sensitive strains of three common organisms to three commonly used drugs were chloramphenicol (95.3%) > ampicillin (83.9%) > penicillin (67.6%). Resistance to penicillin has increased while simultaneous resistance to ampicillin and chloramphenicol has emerged as a new problem among the three common bacteria. It is concluded that although the combination of ampicillin and chloramphenicol is still reasonable for initial "blind" therapy of meningitis, the emergence of multiple drug resistance suggests the need for consideration of a revision of current practice. The third generation cephalosporins are suggested as a suitable alternative.
1985年至1990年期间，在尼日利亚贝宁城对253例经培养证实的1个月以上婴儿和1岁以下儿童细菌性脑膜炎病例进行研究，结果显示，49.8%的病例由脑膜炎奈瑟菌引起，21.4%由肺炎链球菌引起，15.4%由流感嗜血杆菌引起，13.4%由其他微生物引起，包括金黄色葡萄球菌和肠杆菌科细菌。与1974年至1984年尼日利亚南部的情况相比，脑膜炎奈瑟菌已取代肺炎链球菌成为最常见的病原体。脑膜炎奈瑟菌在2岁以下相对少见，而流感嗜血杆菌在5岁后罕见。大约一半的金黄色葡萄球菌和肠杆菌科细菌分离株来自6个月及以下的婴儿。三种常见病原体对三种常用药物的敏感菌株比例分别为：氯霉素（95.3%）>氨苄西林（83.9%）>青霉素（67.6%）。对青霉素的耐药性有所增加，而对氨苄西林和氯霉素的同时耐药已成为这三种常见细菌中的一个新问题。结论是，虽然氨苄西林和氯霉素联合用药对于脑膜炎的初始“经验性”治疗仍然合理，但多重耐药性的出现表明需要考虑修订当前的治疗方法。建议使用第三代头孢菌素作为合适的替代药物。
