自从抗生素时代开始以来,细菌性脑膜炎的治疗已很混乱,某些药在体外对病原体有效,而在体内不能获得同样疗效。本文目的是从动物和人体研究中搜集资料来综述治疗原则,并提出评价新药的最低标准的指标。应用抗生素的早期已认识到,在感染区,如脑脊液和脑血管周围窝药物要达到抗微生物作用有困难,β-内酰胺抗生素在生理性 pH 时能高度电离,因此很难透过血脑屏障的脂质膜。此外脉络膜丛的主动输出泵迅速将这些药物从脑脊液中分泌排出,并回到血流中。虽然在脑膜炎症时期,脑脊液中青霉素的浓度,对病原体的敏感性来说相对较大,在实验动物中,它们很少超过同期内血清中药物浓度的15%。那 Since the beginning of the antibiotic era, the treatment of bacterial meningitis has become very chaotic. Some drugs are effective against pathogens in vitro but not in the body. The purpose of this paper is to collect data from both animal and human studies to summarize the principles of treatment and to propose indicators for evaluating the minimum standards for new drugs. Early in the use of antibiotics, it has been recognized that it is difficult to achieve antimicrobial action in infected areas, such as cerebrospinal fluid and perivascular fossa. Beta-lactam antibiotics are highly ionizable at physiological pH and therefore difficult to penetrate the blood-brain barrier Lipid membrane. In addition, the active output pump of the choroid plexus rapidly excretes these drugs from the cerebrospinal fluid and returns to the bloodstream. Although the concentration of penicillin in cerebrospinal fluid during the period of meningitis is relatively high for pathogen sensitivity, in experimental animals they seldom exceed 15% of the serum concentration of the drug over the same period. that