万古霉素和利奈唑胺治疗儿童中枢神经系统感染研究进展

Research Progress of Vancomycin and Linezolid on the Treatment of Central Nervous System Infections in Children

关键词:  万古霉素  利奈唑胺  中枢神经系统  感染  

Key words:  vancomycin  linezolid  central nervous system  infection  children

摘要:

儿童发生中枢神经系统感染时，尤其是多重耐药革兰氏阳性菌株感染时，万古霉素常常作为一线选择药物。糖肽类在正常脑脊液（cerebrospinal fluid，CSF）中药物浓度低，而在脑膜炎症时，万古霉素透入血脑屏障的药物增多，但CSF/血浆的AUC比值个体差异很大，常常导致治疗失败。利奈唑胺常用于治疗严重的革兰氏阳性菌株中枢神经系统感染，其在CSF中药物浓度与血浆中游离的药物浓度接近，透入血脑屏障基本不受脑膜炎症的影响。但利奈唑胺未批准用于中枢神经系统感染。因此，评估万古霉素和利奈唑胺治疗儿童多重耐药革兰氏阳性菌中枢神经系统感染的临床效果和不良反应仍然是重要的研究方面。

Abstract:

Vancomycin is usually selected as first-line antibacterial drugs in treatment of central nervous system(CNS) infection especialy in multidrug-resistant gram-positive strains. Glycopeptides achieve relatively low cerebrospinal fluid(CSF concentrations). However, inflamed meninges enhance the distribution of vancomycin into CSF, but the AUC ratio(CSF:serum) of vancomycin varies from person to person, which usually lead to treatment failure. Linezolid is often used to treat severe Gram-positive infections at the CNS level. CSF linezolid concentrations have been found similar to those of the free fraction in plasma, whereas the presence of inflammation seems not to influence linezolid penetration into CSF. But, it is not licenced using linezolid in CNS infections treatment. It is important to reseach the clinical effect and adverse drug reaction of vancomycin and linezolid in the treatment of multidrug-resistant gram-positive strains of CNS infections in children.