ペニシリン耐性肺炎球菌性髄膜炎におけるクロラムフェニコル治療の失敗
1Department of Paediatrics, Baragwanath Hospital, Johannesburg, South Africa.
Lancet (London, England)
|February 15, 1992
まとめ
クロランフェニコルは,ペニシリン耐性性ストレプトコッカス肺炎 (PRSP) によって引き起こされる髄膜炎の治療に効果がありません. PRSP髄膜炎患者は著しく悪化した結果を示し,セファロスポリンなどの代替治療法の必要性を強調した.
科学分野:
- 感染症 感染症は感染症です.
- 小児科は小児科です.
- 薬理学 薬理学とは
背景:
- 髄膜炎の治療には,一般的にペニシリンとクロラムフェニコルが含まれています.
- 世界的にペニシリン耐性新型肺炎菌 (PRSP) の発生率が上昇していることから,治療の有効性に関する懸念が高まっている.
- PRSP髄膜炎に対するクロラムフェニコルの有効性は,依然としてほとんど不明です.
研究 の 目的:
- ペニシリンとクロラムフェニコルで治療された肺炎球菌性髄膜炎を患った子どもを将来的に評価する.
- ペニシリン感受性S.pneumoniae (PSSP) とPRSP髄膜炎とのアウトカムを比較する.
- PRSP髄膜炎に対する現在のクロラムフェニコル感受性の定義の適性を評価する.
主な方法:
- 肺炎球菌性髄膜炎を患った68人の子どもを27ヶ月間,前向きに評価した.
- PSSPとPRSPグループ間の臨床結果 (死亡,神経学的欠陥,臨床応答) の比較.
- 治療結果に関連してクロラムフェニコルの最小殺菌濃度 (MBC) の分析.
主要な成果:
- PRSP髄膜炎を患った25人のうち20人 (80%) の子どもが不満足な結果を示した.
- PSSP髄膜炎の43人の子供のうち14人 (33%) が有害な結果 (p < 0.001) を示した.
- PRSP単離におけるクロラムフェニコルのMBC値の上昇は,境界線脳脊髄液の殺菌活動と治療失敗と相関する.
結論:
- クロランフェニコルは,PRSP髄膜炎における高い治療失敗率と関連しています.
- クロラムフェニコルの感受性の現在の定義は,PRSPに対して不適切である可能性があります.
- 第3世代のセファロスポリンなどの代替抗生物質は,PRSP髄膜炎に対して推奨されます.
関連する概念動画
COPD: Management Using Bronchodilators and Corticosteroids
Chronic obstructive pulmonary isease (COPD) involves a group of progressive lung disorders characterized by persistent airflow limitation and chronic respiratory symptoms. Asthma-COPD Overlap Syndrome (ACOS), encompassing features of both asthma and Chronic obstructive pulmonary disease (COPD), is a group of progressive lung disorders that includes chronic bronchitis, emphysema, and refractory (non-reversible) asthma. ACOS leads to complex clinical presentations that combine the inflammatory...
Treatment for Pulmonary Arterial Hypertension: Oxygen Therapy for Respiratory Failure
Oxygen therapy has emerged as a significant tool in enhancing the quality of life for patients suffering from pulmonary arterial hypertension (PAH). While this therapy has principally been studied on patients with significant hypoxemia, this therapeutic approach helps prevent potential organ damage and can be administered in the comfort of one's home.
Oxygen therapy is vital in increasing and maintaining blood oxygen levels in PAH patients. As a result, it aids in reducing fatigue, improving...
Oxygen therapy is vital in increasing and maintaining blood oxygen levels in PAH patients. As a result, it aids in reducing fatigue, improving...
Pneumonia IV: Management
The treatment of pneumonia varies based on its severity and the causative pathogen. Here is a structured approach to managing pneumonia, integrating pharmaceutical and supportive care strategies.
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
Pulmonary Tuberculosis I
Tuberculosis, often called TB, is a contagious illness primarily caused by Mycobacterium tuberculosis. It mainly affects the lung parenchyma but can also impact other body parts.
Causative Organism
The primary infectious agent causing tuberculosis is Mycobacterium tuberculosis, a slow-growing, acid-fast, aerobic rod that exhibits sensitivity to heat and ultraviolet light. Instances of Mycobacterium bovis and Mycobacterium avium contributing to the development of TB infection are rare.
Mode of...
Causative Organism
The primary infectious agent causing tuberculosis is Mycobacterium tuberculosis, a slow-growing, acid-fast, aerobic rod that exhibits sensitivity to heat and ultraviolet light. Instances of Mycobacterium bovis and Mycobacterium avium contributing to the development of TB infection are rare.
Mode of...
Acute Respiratory Failure-V
The treatment for acute respiratory failure varies based on factors like the underlying cause, overall health, and severity. A collaborative healthcare team is essential for early detection, often through arterial blood gas analysis. Identifying the cause is the primary goal, with treatment strategies adjusted for ventilation/perfusion (V/Q) mismatch, shunting, or diffusion impairment.
Ensure that patients are monitored continuously for their response to therapy, including changes in...
Ensure that patients are monitored continuously for their response to therapy, including changes in...
Cryptococcal Meningitis
Cryptococcal meningitis is a life-threatening opportunistic infection predominantly associated with HIV/AIDS, accounting for over 100,000 deaths annually worldwide. However, it also affects individuals with other forms of immunosuppression, including those undergoing immunosuppressive therapy, organ transplant recipients, patients with innate immunodeficiencies, and individuals with hematological disorders. The infection is caused mainly by Cryptococcus neoformans and Cryptococcus gattii,...


