Brook Itzhak
Department of Pediatrics, School of Medicine, Georgetown University, 4431 Albemarle St. NW, Washington, DC 20016, USA.
Int J Antimicrob Agents. 2004 Jul;24(1):18-23. doi: 10.1016/j.ijantimicag.2004.02.016.
The selection of the most effective antimicrobial to treat acute otitis media (AOM) has become more difficult in recent years because of increasing antibiotic resistance among all AOM pathogens. Resistance of Streptococcus pneumoniae to penicillin as well as amoxicillin ranges from 30 to 55% in the USA. Currently, 40-55% of Haemophilus influenzae and 90-100% of Moraxella catarrhalis are resistant to penicillin because of the production of Beta-lactamases. This review discusses the availability of oral cephalosporins that can be utilised for the treatment of AOM in children. An evaluation is made regarding their in vitro activity against the pathogens, their middle-ear concentrations, pharmacokinetics and pharmacodynamics (PK/PD). The cephalosporins that will be discussed are cefuroxime-axetil, cefprozil, cefdinir and cefpodoxime-proxetil. The current recommendations for therapy of AOM limit the choices of clinicians to a single cephalosporin (cefuroxime-axetil). However, clinical, bacteriological and PK/PD data shows that several other cephalosporins (cefprozil, cefdinir and cefpodoxime-proxetil) possess similar indices which provide the clinician with wider therapeutic choices that can insure better compliance and ultimately better success in eradication of the infection.
近年来，由于急性中耳炎（AOM）所有病原体的抗生素耐药性不断增加，选择最有效的抗菌药物来治疗急性中耳炎变得更加困难。在美国，肺炎链球菌对青霉素以及阿莫西林的耐药率在30%至55%之间。目前，40%-55%的流感嗜血杆菌和90%-100%的卡他莫拉菌由于产生β-内酰胺酶而对青霉素耐药。这篇综述讨论了可用于治疗儿童急性中耳炎的口服头孢菌素的可用性。对它们针对病原体的体外活性、中耳浓度、药代动力学和药效学（PK/PD）进行了评估。将要讨论的头孢菌素是头孢呋辛酯、头孢丙烯、头孢地尼和头孢泊肟酯。目前关于急性中耳炎治疗的建议将临床医生的选择限制在单一的头孢菌素（头孢呋辛酯）上。然而，临床、细菌学和PK/PD数据表明，其他几种头孢菌素（头孢丙烯、头孢地尼和头孢泊肟酯）具有相似的指标，这为临床医生提供了更广泛的治疗选择，从而可以确保更好的依从性，并最终在根除感染方面取得更好的成效。
