Klein N C, Cunha B A
Infectious Disease Division, Winthrop-University Hospital, Mineola, New York 11501, USA.
Adv Ther. 1995 Mar-Apr;12(2):83-101.
Cephalosporins are among the most frequently prescribed antibiotics as a result of their broad spectrum of microbiologic activity, favorable pharmacokinetics, low incidence of adverse reactions, and proven clinical efficacy for a wide variety of infections. Cephalosporins differ in their gram-positive, gram-negative, and anaerobic spectra, serum half-lives, penetration of the cerebrospinal fluid, and resistance to beta-lactamases. The first-generation and some second-generation agents maintain excellent activity against streptococci and staphylococci, while the third-generation agents have expanded gram-negative coverage. Two third-generation cephalosporins, ceftazidime and cefoperazone, are active against Pseudomonas. Ceftizoxime has become the workhorse third-generation cephalosporin. The fourth-generation agent cefepime provides excellent activity against gram-positive and gram-negative pathogens, including antibiotic-resistant Enterobacteriaceae. A major dilemma facing the practitioner is how to select the "right" cephalosporin for a particular patient, as no one drug will satisfy all clinical needs. This review describes a practical approach to selecting an appropriate cephalosporin for common infectious disease problems.
由于头孢菌素具有广泛的微生物活性谱、良好的药代动力学、不良反应发生率低以及对多种感染已证实的临床疗效，它们是最常被处方的抗生素之一。头孢菌素在革兰氏阳性菌、革兰氏阴性菌和厌氧菌谱、血清半衰期、脑脊液穿透性以及对β-内酰胺酶的耐药性方面存在差异。第一代和一些第二代药物对链球菌和葡萄球菌保持着优异的活性，而第三代药物扩大了革兰氏阴性菌的覆盖范围。两种第三代头孢菌素，头孢他啶和头孢哌酮，对铜绿假单胞菌有活性。头孢唑肟已成为主要的第三代头孢菌素。第四代药物头孢吡肟对革兰氏阳性和革兰氏阴性病原体包括耐药肠杆菌科细菌具有优异的活性。从业者面临的一个主要困境是如何为特定患者选择“正确的”头孢菌素,因为没有一种药物能满足所有临床需求。本综述描述了一种为常见传染病问题选择合适头孢菌素的实用方法。
