Sorice F, Ortona L, Pizzigallo E
Minerva Med. 1975 Sep 5;66(57):2805-22.
A brief account of the aims sought by multiple antibiotic management is followed by an assessment of the antagonism and synergism displayed by associations of two bactericidal antibiotics, two bacteriostatic antibiotics, and one bactericidal and one bacteriostatic antibiotic. Instances of synergism between bactericides (particularly penicillins and aminosides) are mentioned. Stress is laid on recent studies on the mechanism of action of antibacterial drugs showing unmistakeable synergism between trimethoprim and sulphamethoxazol and between chloramphenicol and tetracycline. The antagonism between bactericides and bacteriostatics noted by Jawetz et Al. has not been confirmed clinically in a number of reported series. The main indications for combined antiobiotic therapy are reviewed: endocarditis, purulent meningitis, staphylococcia, brucellosis, salmonellosis, shigellosis, other Gram-negative infections and fever in the course of blood diseases. References is made to personal experience in the management of 35 cases of bacterial endocarditis, 15 cases of purulent meningitis and various forms of serious Gram-negative infection. Leaving aside exceptional cases, the clinical effects of antibiotic associations are uncertain and influenced by too many variables. The technique is still of importance, however, despite the introduction of many new antibiotics. It must not be thought of as a handy method for indiscriminate use, however; its indications (which are summarised) are quite clear.
在简述了多种抗生素管理所追求的目标之后，对两种杀菌性抗生素、两种抑菌性抗生素以及一种杀菌性抗生素和一种抑菌性抗生素组合所表现出的拮抗作用和协同作用进行了评估。文中提到了杀菌剂之间（特别是青霉素类和氨基糖苷类）的协同作用实例。重点介绍了近期关于抗菌药物作用机制的研究，这些研究表明甲氧苄啶和磺胺甲恶唑之间以及氯霉素和四环素之间存在明显的协同作用。Jawetz等人指出的杀菌剂和抑菌剂之间的拮抗作用在一些报道的系列研究中尚未得到临床证实。本文回顾了联合抗生素治疗的主要适应证：心内膜炎、化脓性脑膜炎、葡萄球菌感染、布鲁氏菌病、沙门氏菌病、志贺氏菌病、其他革兰氏阴性菌感染以及血液病过程中的发热。文中还提及了个人治疗35例细菌性心内膜炎、15例化脓性脑膜炎和各种严重革兰氏阴性菌感染的经验。除了特殊情况外，抗生素联合使用的临床效果尚不确定，且受太多变量影响。然而，尽管引入了许多新抗生素，联合使用技术仍然很重要。不过，绝不能将其视为一种随意使用的简便方法；其适应证（已总结）相当明确。
