Hsueh Po-Ren, Huang Wen-Kuei, Shyr Jainn-Ming, Lau Yeu-Jun, Liu Yung-Ching, Luh Kwen-Tay
Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei.
J Formos Med Assoc. 2004 Sep;103(9):664-70.
Data on the in vitro activities of orally administered cephalosporins, particularly third-generation cephalosporins, against recent pathogens responsible for community-respiratory tract infection are lacking.
A susceptibility surveillance of 267 isolates of Streptococcus pneumoniae, 205 of Streptococcus pyogenes, 204 of Haemophilus influenzae, and 147 of Moraxella catarrhalis to 14 oral antimicrobial agents using the agar dilution method was carried out from March 2002 to October 2002 in Taiwan.
High rates of non-susceptibility to penicillin (60%), cefaclor (67%), cefuroxime (62%), cefpodoxime (64%), clarithromycin (91%), and trimethoprim-sulfamethoxazole (98%) for S. pneumoniae isolates and high rates of non-susceptibility to ampicillin (70%), clarithromycin (34%), and trimethoprim-sulfamethoxazole (63%) for H. influenzae isolates were found. The rank order of oral cephalosporin activity based on the minimum concentrations at which 90% of the isolates were inhibited (MIC90s) for S. pneumoniae was cefpodoxime > cefuroxime > cefixime > cefaclor, cephradine > cephalexin and for H. influenzae and M. catarrhalis was cefixime > cefpodoxime > cefuroxime > cefaclor > cephalexin, cephradine. Among the 75 S. pneumoniae isolates resistant to penicillin (MICs ranged 2 to 4 mg/L), 4% were intermediate to amoxicillin and > 90% were resistant to cefaclor, cefuroxime, and cefpodoxime. For S. pyogenes isolates, all were susceptible to penicillin, 21% were not susceptible to clarithromycin and 4% were not susceptible to clindamycin. Thirty four percent of H. influenzae isolates were not susceptible to clarithromycin. The MIC90 of clarithromycin against M. catarrhalis isolates was 0.5 mg/L.
Cefpodoxime, cefixime, and cefuroxime are promising agents against these bacterial pathogens, except for penicillin-non-susceptible S. pneumoniae isolates.
目前缺乏口服头孢菌素，尤其是第三代头孢菌素对近期引起社区呼吸道感染病原体的体外活性数据。
2002年3月至10月在台湾采用琼脂稀释法对267株肺炎链球菌、205株化脓性链球菌、204株流感嗜血杆菌和147株卡他莫拉菌进行了对14种口服抗菌药物的敏感性监测。
肺炎链球菌分离株对青霉素（60%）、头孢克洛（67%）、头孢呋辛（62%）、头孢泊肟酯（64%）、克拉霉素（91%）和甲氧苄啶 - 磺胺甲恶唑（98%）的不敏感率较高，流感嗜血杆菌分离株对氨苄西林（70%）、克拉霉素（34%）和甲氧苄啶 - 磺胺甲恶唑（63%）的不敏感率较高。基于90%分离株被抑制的最低浓度（MIC90s），口服头孢菌素对肺炎链球菌的活性排序为头孢泊肟酯>头孢呋辛>头孢克肟>头孢克洛、头孢拉定>头孢氨苄，对流感嗜血杆菌和卡他莫拉菌的活性排序为头孢克肟>头孢泊肟酯>头孢呋辛>头孢克洛>头孢氨苄、头孢拉定。在75株对青霉素耐药（MIC范围为2至4mg/L）的肺炎链球菌分离株中，4%对阿莫西林中介，>90%对头孢克洛、头孢呋辛和头孢泊肟酯耐药。对于化脓性链球菌分离株，所有菌株对青霉素敏感，21%对克拉霉素不敏感，4%对克林霉素不敏感。34%的流感嗜血杆菌分离株对克拉霉素不敏感。克拉霉素对卡他莫拉菌分离株的MIC90为0.5mg/L。
除对青霉素不敏感的肺炎链球菌分离株外，头孢泊肟酯、头孢克肟和头孢呋辛是针对这些细菌病原体的有前景的药物。
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