Nicolle L E
Health Sciences Centre, Winnipeg, MB, Canada.
J Antimicrob Chemother. 2000 Sep;46 Suppl 1:35-9; discussion 63-5.
The efficacy of pivmecillinam for empirical treatment of acute uncomplicated urinary tract infection (UTI) was initially reported in clinical trials published in the 1970s and 1980s. Bacteriological cure rates observed in these trials were consistently >85%, and studies of different dosing regimens suggested that a 3 day course was appropriate. Comparative studies reported that pivmecillinam was equivalent to other antimicrobial agents in terms of clinical and bacteriological outcomes. These studies also documented that pivmecillinam was effective for treatment of Staphylococcus saprophyticus infections, was acceptable for use in pregnancy and was well tolerated. Subsequent widespread use of pivmecillinam in Scandinavian countries has led to a body of clinical experience which confirms the efficacy and safety of this antimicrobial agent in the treatment of acute cystitis. Recently, two large, prospective, randomized, double-blind, multi-centre clinical trials have been completed to assist in defining the role of this antimicrobial agent in the treatment of acute cystitis. A comparison of 3 day courses of pivmecillinam or norfloxacin, both at 400 mg bd, showed higher bacteriological cure rates with norfloxacin but generally similar clinical outcomes. A second, dose-ranging study found that pivmecillinam, given bd for 7 days, led to superior bacteriological and clinical outcomes at short-term follow-up than the 3 day regimen. Pooling bacteriological outcomes from the two studies showed similar outcomes with 7 days of pivmecillinam 200 mg bd or 3 days of norfloxacin 400 mg bd. The shorter, 3 day, course achieved similar short-term clinical outcomes to 7 days of pivmecillinam and 3 days of norfloxacin in women aged < or =50 years. These recent studies confirm earlier reports and clinical experience that pivmecillinam is effective and well tolerated for the treatment of acute cystitis in women.
匹美西林用于急性单纯性尿路感染（UTI）经验性治疗的疗效最初在20世纪70年代和80年代发表的临床试验中有所报道。这些试验中观察到的细菌学治愈率始终>85%，不同给药方案的研究表明3天疗程是合适的。比较研究报告称，匹美西林在临床和细菌学结果方面与其他抗菌药物相当。这些研究还证明，匹美西林对腐生葡萄球菌感染有效，可用于妊娠期，且耐受性良好。随后，匹美西林在斯堪的纳维亚国家广泛使用，积累了大量临床经验，证实了这种抗菌药物在治疗急性膀胱炎方面的疗效和安全性。最近，两项大型、前瞻性、随机、双盲、多中心临床试验已完成，以协助确定这种抗菌药物在治疗急性膀胱炎中的作用。比较匹美西林或诺氟沙星400mg bid的3天疗程，结果显示诺氟沙星的细菌学治愈率更高，但临床结果总体相似。第二项剂量范围研究发现，匹美西林bid给药7天，在短期随访中比3天疗程的细菌学和临床结果更好。汇总两项研究的细菌学结果显示，匹美西林200mg bid治疗7天与诺氟沙星400mg bid治疗3天的结果相似。在年龄≤50岁的女性中，较短的3天疗程与匹美西林治疗7天和诺氟沙星治疗3天的短期临床结果相似。这些最新研究证实了早期报告和临床经验，即匹美西林对治疗女性急性膀胱炎有效且耐受性良好。
