头孢他定椎管内持续给药治疗化脓性脑膜炎(附首例报告)

Continuous intraspinal ceftazidime administration in a case for treatment of purulent meningitis

目的探讨头孢他定椎管内持续给药治疗化脓性脑膜炎的可行性。方法临床确诊1例无色杆菌属感染的化脓性脑膜炎,给予静脉注射头孢他定4g/d,并进行腰大池置管外引流。3d后在静脉注射头孢他定的同时经腰大池置管给予头孢他定椎管内持续给药0.2g/d,3d后症状明显缓解,拔除腰大池管,继续静脉注射头孢他定1周。结果头孢他定椎管内持续给药同时静脉注射疗效明显好于单纯静脉注射,曾经尝试鞘内注射头孢他定患者无法耐受。结论头孢他定椎管内持续给药治疗化脓性脑膜炎安全有效。

Objective To investigate the feasibility of continuous intraspinal ceftazidime administration for treatment of purulent meningitis due to Achromobacter infection. Methods A patient with established diagnosis of purulent meningitis due to Achromobacter infection was admitted, who failed to respond favorably to a 3-day ceftazidime treatment administered intravenously. Continuous intraspinal ceftazidime administration at the dose of 0.2 g/d was then attempted through a catheter placed in the cistema magna in addition to intravenous ceftazidime for 3 days, which resulted in obvious relief of the symptoms. The catheter was subsequently withdrawn, and the patient received further treatment with additional intravenous ceftazidime for a week. Results The symptoms of purulent meningitis was significantly improved atter a 3-day continuous intraspinal ceftazidime administration, and the patient was eventually cured after completion of the treatment course. Intrathecal ceftazidime was also attempted previously but failed due to intolerance of pains in the legs. No relapse was observed in this case 3 months after the discharge. Conclusion Continuous intraspinal ceftazidime administration can be effective and safe for treatment of purulent meningitis.