Burgess David S, Nathisuwan Surakit
College of Pharmacy, The University of Texas at Austin, Austin, TX, USA.
Diagn Microbiol Infect Dis. 2002 Sep;44(1):35-41. doi: 10.1016/s0732-8893(02)00420-0.
A beta-lactam plus an aminoglycoside is the standard for treating severe Pseudomonas aeruginosa infections. However, the fluoroquinolones are safer and have been widely used as an alternative to the aminoglycosides in this setting. In this study we compared the synergistic activities of piperacillin/tazobactam and cefepime when either drug was combined with gentamicin, ciprofloxacin, or levofloxacin against P. aeruginosa. Susceptibility testing and time-kill curves were performed against 12 clinical isolates of P. aeruginosa. All combinations were bactericidal and retained this activity over the 24 hr period except for piperacillin/tazobactam in combination with levofloxacin or ciprofloxacin against 2 isolates and cefepime in combination with levofloxacin against 1 isolate. None of the combinations were antagonistic. No statistical difference in the frequency of synergy exists between the beta-lactam plus gentamicin (79%) and the beta-lactams plus either ciprofloxacin or levofloxacin combinations (58%, 67%). Furthermore, no differences in synergistic activity were noted between ciprofloxacin combinations (58%) and levofloxacin combinations (67%). In conclusion, the degree of synergy between a beta-lactam plus aminoglycoside and a beta-lactam plus fluoroquinolone seem to be comparable. Furthermore, there is a similar rate of synergy among different fluoroquinolone-based combinations. However, faster killing, less regrowth, and decrease in the development of resistance were seen with the beta-lactam plus aminoglycoside combination.
β-内酰胺类药物加氨基糖苷类药物是治疗严重铜绿假单胞菌感染的标准方案。然而，氟喹诺酮类药物更安全，在这种情况下已被广泛用作氨基糖苷类药物的替代品。在本研究中，我们比较了哌拉西林/他唑巴坦和头孢吡肟分别与庆大霉素、环丙沙星或左氧氟沙星联合使用时对铜绿假单胞菌的协同活性。对12株铜绿假单胞菌临床分离株进行了药敏试验和时间杀菌曲线测定。除哌拉西林/他唑巴坦与左氧氟沙星或环丙沙星联合使用对2株分离株、头孢吡肟与左氧氟沙星联合使用对1株分离株外，所有联合用药在24小时内均具有杀菌活性且保持该活性。所有联合用药均无拮抗作用。β-内酰胺类药物加庆大霉素（79%）与β-内酰胺类药物加环丙沙星或左氧氟沙星联合用药（58%，67%）之间的协同频率无统计学差异。此外，环丙沙星联合用药（58%）和左氧氟沙星联合用药（67%）之间的协同活性也无差异。总之，β-内酰胺类药物加氨基糖苷类药物与β-内酰胺类药物加氟喹诺酮类药物之间的协同程度似乎相当。此外，不同氟喹诺酮类药物联合用药的协同率相似。然而，β-内酰胺类药物加氨基糖苷类药物联合用药的杀菌速度更快、再生长更少且耐药性发展降低。
