氟氯西林治疗甲氧西林敏感金黄色葡萄球菌所致脑膜炎1例并文献复习  

Flucloxacillin in the treatment of meningitis caused by methicillin sensitive Staphylococcus aureus:one case report and literature review

作　　者：林志强[1] 吴娜梅 蔡莉莉 LIN Zhiqiang;WU Namei;CAI Lili(Department of Pharmacy,Quanzhou First Hospital Affiliated to Fujian Medical University,Quanzhou Fujian 362000,China)

机构地区：[1]福建医科大学附属泉州第一医院药剂科,福建泉州362000

出　　处：《中国感染与化疗杂志》2021年第1期56-61,共6页Chinese Journal of Infection and Chemotherapy

摘　　要：目的探讨氟氯西林治疗甲氧西林敏感金黄色葡萄球菌(MSSA)所致脑膜炎的疗效和安全性。方法分析氟氯西林治疗1例MSSA所致脑膜炎作用,并检索国内外报道的氟氯西林治疗MSSA所致脑膜炎的病例,综合进行分析。结果该患者采用氟氯西林2 g,1次/6 h静脉滴注,治疗23 d,患者最后痊愈出院,用药期间出现低钾血症。文献检索到32例病例报道,其中社区获得性脑膜炎9例,医院获得性脑膜炎23例,治愈率81.2%。2例患者同时监测氟氯西林的血药浓度和脑脊液浓度,其中1例合并低蛋白血症的危重成人患者的血和脑脊液药物浓度不能达到治疗水平,1例3月龄患儿的血和脑脊液浓度能达到足够的治疗水平,2例患者最终都治疗成功。结论氟氯西林可用于治疗MSSA所致细菌性脑膜炎,但需要积累更多的循证证据。低蛋白血症可降低氟氯西林的体内药物浓度。当用于治疗成人细菌性脑膜炎等危重感染时,宜采用8~12 g/d持续静脉滴注给药。对于年龄小于1岁的儿童,脑脊液药物浓度更易达到治疗水平。接受大剂量氟氯西林的患者需要注意监测血钾。Objective To review the efficacy and safety of flucloxacillin in the treatment of meningitis caused by methicillin sensitive Staphylococcus aureus(MSSA).Methods A case of meningitis caused by MSSA was treated with flucloxacillin.Similar cases of meningitis caused by MSSA and treated with flucloxacillin were searched and analyzed comprehensively.Results Flucloxacillin 2 g was given q6h by intravenous infusion to treat the patient for 23 days.The patient finally recovered.Hypokalemia occurred during the treatment.A total of 32 similar cases were identified from literature search,including 9 cases of community-acquired meningitis,23 cases of hospital acquired meningitis.The cure rate was 81.2%.Flucloxacillin concentration in blood and cerebrospinal fluid was monitored in two patients.Flucloxacillin concentration in blood and cerebrospinal fluid did not reach the therapeutic concentration in one adult with hypoproteinemia;but reached sufficient therapeutic concentration in a 3-month-old infant.Both patients were finally cured.Conclusions Flucloxacillin can be used to treat bacterial meningitis caused by MSSA,but more evidence is required.The concentration of flucloxacillin decreases in case of hypoproteinemia.Continuous intravenous infusion of 8-12 g/d flucloxacillin should be considered for the treatment of critical infections,such as bacterial meningitis in adults.It is more likely for flucloxacillin to reach the therapeutic concentration in the cerebrospinal fluid of infants under 1 year old.Serum potassium should be monitored when patients is receiving high dose flucloxacillin.

关 键 词：氟氯西林 脑膜炎 金黄色葡萄球菌 低蛋白血症 低钾血症 

分 类 号：R978.11[医药卫生—药品] R512.3[医药卫生—药学]