de Louvois J, Gortvai P, Hurley R
Br Med J. 1977 Oct 15;2(6093):985-7. doi: 10.1136/bmj.2.6093.985.
Samples of intracranial pus and serum from 32 patients were assayed to determine the concentrations reached in them of penicillin, ampicillin, cloxacillin, cephaloridine, gentamicin, chloramphenicol, fusidic acid, and lincomycin. Metronidazole had not been given. Penicillin penetrated abscesses reasonably well, but other beta-lactam antibiotics did not. The penetration of chloramphenicol was erratic. Aminoglycosides penetrated poorly, but lincomycin and fusidic acid penetrated well. Assay of sulphonamides and co-trimoxazole in pus was unreliable. These studies indicate that treatment of abscesses of the central nervous system should be considered according to the site and the likely antecedent cause. Abscesses of sinusitic origin, usually in the frontal lobe, yield penicillin-sensitive streptococci. Penicillin is the drug of choice. Abscesses of otitic origin, usually in the temporal lobe, yield a mixed flora, often including anaerobic bacteria. Multiple antibiotic therapy is indicated. Abscesses of metastatic or cryptogenic origin yield streptococci or mixed cultures, and multiple therapy is appropriate while awaiting the bacteriological results. Spinal and post-traumatic abscesses yield Staphylococcus aureus, and fusidic acid is the drug of choice.
对32例患者的颅内脓液和血清样本进行检测，以确定其中青霉素、氨苄西林、氯唑西林、头孢菌素、庆大霉素、氯霉素、夫西地酸和林可霉素的浓度。未使用甲硝唑。青霉素能较好地穿透脓肿，但其他β-内酰胺类抗生素则不能。氯霉素的穿透情况不稳定。氨基糖苷类药物穿透性差，但林可霉素和夫西地酸穿透性良好。对脓液中的磺胺类药物和复方新诺明进行检测不可靠。这些研究表明，中枢神经系统脓肿的治疗应根据其部位和可能的病因来考虑。鼻窦源性脓肿通常位于额叶，产生对青霉素敏感的链球菌。青霉素是首选药物。耳源性脓肿通常位于颞叶，产生混合菌群，常包括厌氧菌。需要进行多种抗生素治疗。转移性或隐源性脓肿产生链球菌或混合培养物，在等待细菌学结果期间进行多种治疗是合适的。脊髓和创伤后脓肿产生金黄色葡萄球菌，夫西地酸是首选药物。
