Cuffini A M, Tullio V, Ianni Palarchio A, Bonino A, Paizis G, Carlone N A
Department of Public Health and Microbiology, University of Turin, Italy.
Drugs Exp Clin Res. 1998;24(4):173-84.
The recent increase in the incidence of infections due to Streptococcus pneumoniae resistant to penicillin and other antibiotics, often associated with considerable morbidity and mortality, has been recognized as an alarming problem. From the recent medical literature data it emerges that among beta-lactam antibiotics used as an empiric treatment for infections caused by S. pneumoniae, amoxycillin and amoxycillin/clavulanic acid are the most active oral antibiotics and may be considered as a first-line therapeutic agent for the treatment of these infections. Since the therapeutic result of the treatment of an infection is determined by the combined effect of the antimicrobials and host defenses, we investigated the effect of amoxycillin, with and without clavulanic acid, upon the in vitro interaction between human polymorphonuclear leukocytes (PMNs) and a penicillin-resistant strain of S. pneumoniae. Amoxycillin significantly inhibited the streptococcal uptake by PMNs referred to the control system. Clavulanic acid did not have any significant effect upon the interaction PMNs-S. pneumoniae. The addition of amoxycillin/clavulanic acid to phagocytes and streptococci resulted in a synergystic potentiation of the activity of both drugs upon the PMN functions towards S. pneumoniae in such a manner that the bacteria became more susceptible to either the phagocytosis or the microbicidal activities of phagocytes. These effects came in addition to the intrinsic, excellent antimicrobial properties of this drug combination. Although the clinical significance of the observed enhanced effects of amoxycillin/clavulanate are far from elucidated, the possibility exists that they may play a contributory role, especially in patients with impaired host defense.
肺炎链球菌对青霉素和其他抗生素耐药导致的感染发病率最近有所上升，常常伴有相当高的发病率和死亡率，这已被公认为是一个令人担忧的问题。从最近的医学文献数据可以看出，在用作肺炎链球菌感染经验性治疗的β-内酰胺类抗生素中，阿莫西林和阿莫西林/克拉维酸是活性最强的口服抗生素，可被视为治疗这些感染的一线治疗药物。由于感染治疗的效果取决于抗菌药物和宿主防御的联合作用，我们研究了有或没有克拉维酸的阿莫西林对人多形核白细胞（PMN）与青霉素耐药肺炎链球菌菌株之间体外相互作用的影响。与对照系统相比，阿莫西林显著抑制了PMN对链球菌的摄取。克拉维酸对PMN与肺炎链球菌之间的相互作用没有任何显著影响。在吞噬细胞和链球菌中添加阿莫西林/克拉维酸会导致两种药物对PMN针对肺炎链球菌的功能的活性产生协同增强作用，使得细菌对吞噬细胞的吞噬作用或杀菌活性更敏感。这些作用是除了这种药物组合固有的优异抗菌特性之外的。尽管阿莫西林/克拉维酸盐观察到的增强作用的临床意义远未阐明，但它们可能发挥作用，尤其是在宿主防御受损的患者中，这种可能性是存在的。
