- 期刊
Pneumococcal Infection in Children: Rational Antibiotic Choice for Drug-Resistant Streptococcus Pneumoniae
兒童時期的肺炎雙球菌感染：對具抗藥性細菌的合理抗生素治療
摘要
肺炎雙球菌是引起兒童時期肺炎、中耳炎、鼻竇炎及腦膜炎的重要細菌。在過去十年肺炎雙球菌的抗藥性節節上昇。台灣地區的抗藥性比例更是幾近全球之冠。引起抗藥性的機轉主要是盤尼西林攜帶蛋白（penicillin-binding protein/簡稱PBP）的改變，因此使用β-lactamase抑制劑並無法克服抗藥性的問題。欲治療肺炎雙球菌感染，必需依(1)感染部位(2)抗藥性的程度來選擇用藥；且現今抗藥性標准分爲二套，即中樞神經感染及非中樞神經感染。一般而言對非中樞神經，susceptible或intermediate之肺炎雙球菌感染，盤尼西林仍具有優良殺菌效果。Vancomycin並不該在所有情況皆做爲第一線用藥。
並列摘要
Streptococcus pneumoniae is one of the most common bacterial causes of otitis media, sinusitis, bacteremia, pneumonia and bacterial meningitis in the pediatric population. The resistance of S. pneumoniae to penicillin and other antimicrobial agents is increasing in many parts of the world. In Taiwan, extremely high prevalence (70%) of penicillin-resistant S. pneumoniae among children with nasopharyngeal carriage has been reported. The mechanism of resistance to penicillin is the alteration of penicillin binding protein (PBP) instead of the production of β-lactamase. Thus β-lactamase inhibitors are not the solution to the treatment of infections caused by penicillin-resistant S. pneumoniae. The adequate treatment of infections caused by penicillin-resistant S. pneumoniae should be based on (1) site of infection (2) degree of resistance. Currently, the MIC breakpoints for S. pneumoniae are divided to 2 categories; one for CNS infection and the other for non-CNS infections. For non-CNS infections caused by susceptible or intermediate S. pneumoniae, penicillin still remains the drug of choice with excellent bactericidal activity. Vancomycin should not be the first choice in treating all pneumococcal infections.
延伸閱讀
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