中枢神经系统抗菌剂的暴露和针对炭脑膜炎的建议剂量
John S Bradley1, Jürgen B Bulitta2, Rachel Cook3
1Department of Pediatrics, University of California-San Diego School of Medicine and Rady Children's Hospital, San Diego, California, USA.
概括
有效的脑脊液 (CSF) 抗菌度对于治疗炭病脑膜炎至关重要. 一些抗生素,包括诺基诺和四环素,显示微生物成功的可能性很高.
科学领域:
- 药理学 药理学是指药理学的学科.
- 传染性疾病 传染性疾病
- 神经科学是一个神经科学.
背景情况:
- 系统性炭病死亡率与炭病脑膜炎中中枢神经系统炎症有关.
- 足够的脑脊液 (CSF) 抗微生物度对于有效的治疗至关重要.
研究的目的:
- 为了评估在CSF中针对Bacillus anthracis感染的抗菌疗效.
- 为了确定最佳的抗菌剂量治疗炭病脑膜炎.
主要方法:
- 对抗微生物血清和CSF暴露的文献和监管文件的审查.
- 使用体外敏感性数据进行人口药理动力学建模和蒙特卡洛模拟.
- 对抗 Bacillus anthracis 与不同脑膜炎症的抗菌活性的评估.
主要成果:
- 对于西普罗素,莱沃素,梅罗,伊米/西拉斯,青素G,安培,安培/苏尔巴克坦,多西环素和米诺环素的成功概率高 (≥95%).
- 对于piperacillin/tazobactam和较高剂量的levofloxacin,可接受的概率 (90% - 95%).
- 范科米辛,阿米卡辛,克林达米辛和线索利德的可能性低 (<90%).
结论:
- 及时的经验性抗菌疗法可以减少炭脑膜炎的发病率和死亡率.
- 建议使用β-乳酸,诺基诺和四环类作为一线或替代药物.
- 由于毒素抑制,克林达米辛和线索利德在联合治疗中可能是有益的.
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