Sanders C V, Aldridge K E
Department of Medicine, LSU Medical Center, New Orleans 70112.
Eur J Clin Microbiol Infect Dis. 1992 Nov;11(11):999-1011. doi: 10.1007/BF01967790.
The treatment of many anaerobic infections involves antimicrobial therapy, appropriate surgical drainage of abscesses, and debridement of devitalized tissue. Most anaerobic infections are polymicrobial and require treatment with agents active against an array of aerobic and anaerobic bacteria. Bacterial resistance, especially to penicillins and tetracyclines, but also to newer agents of other classes, continues to increase. As a result, treatment with more than one drug is often required. Combination therapy is often necessary in serious infection, and is indicated for empiric treatment before receiving culture results. In the past combination therapy has been the mainstay of antimicrobial therapy, but more recent studies suggest that monotherapy for anaerobic infections may dominate the future. Selection of an agent requires consideration of the site of infection and the most likely etiologic agents. In vitro susceptibility is important, but it is not the only determinant of antimicrobial effectiveness. The pharmacology of the drug--absorption, distribution, concentrations in body fluids and tissues, excretion and metabolism--also plays an important role. The nature and severity of the underlying illness are important factors in selecting empiric therapy. Although it is a clinical judgement, in patients considered to have mild to moderate infections, several factors in selecting antimicrobial agents may be considered, including cost, whereas in patients judged to have severe or life-threatening infections, the most potent agents should be chosen as initial therapy, regardless of cost. Finally, the toxicities of the agent must also be considered.
许多厌氧菌感染的治疗包括抗菌治疗、对脓肿进行适当的外科引流以及清除失活组织。大多数厌氧菌感染是多菌混合感染，需要使用对一系列需氧菌和厌氧菌有效的药物进行治疗。细菌耐药性，尤其是对青霉素和四环素的耐药性，以及对其他类别的新型药物的耐药性，持续增加。因此，常常需要使用不止一种药物进行治疗。联合治疗在严重感染中往往是必要的，并且在获得培养结果之前用于经验性治疗。过去，联合治疗一直是抗菌治疗的主要方法，但最近的研究表明，厌氧菌感染的单一疗法可能主导未来。选择药物需要考虑感染部位和最可能的病原体。体外药敏试验很重要，但它不是抗菌效果的唯一决定因素。药物的药理学——吸收、分布、在体液和组织中的浓度、排泄和代谢——也起着重要作用。基础疾病的性质和严重程度是选择经验性治疗的重要因素。虽然这是一种临床判断，但对于被认为患有轻至中度感染的患者，选择抗菌药物时可能会考虑几个因素，包括成本，而对于被判定患有严重或危及生命感染的患者，应选择最有效的药物作为初始治疗，而不考虑成本。最后，还必须考虑药物的毒性。
