Duplessis Christopher, Crum-Cianflone Nancy F
Infectious Disease Division, Naval Medical Center San Diego, San Diego, CA United States.
Clin Med Rev Ther. 2011 Feb 10;3. doi: 10.4137/CMRT.S1637.
Microbial resistance has reached alarming levels, threatening to outpace the ability to counter with more potent antimicrobial agents. In particular, methicillin-resistant Staphylococcus aureus (MRSA) has become a leading cause of skin and soft-tissue infections and PVL-positive strains have been associated with necrotizing pneumonia. Increasing reports of growing resistance to glycopeptides have been noted, further limiting the efficacy of standard antibiotics, such as vancomycin. Ceftaroline is a novel fifth-generation cephalosporin, which exhibits broad-spectrum activity against Gram-positive bacteria, including MRSA and extensively-resistant strains, such as vancomycin-intermediate S. aureus (VISA), heteroresistant VISA (hVISA), and vancomycin-resistant S. aureus (VRSA). In addition to being an exciting new agent in the anti-MRSA armamentarium, ceftaroline provides efficacy against many respiratory pathogens including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Ceftaroline (600 mg intravenously every 12 hours) has been shown effective in phase III studies in the treatment of complicated skin and soft tissue infections and community-acquired pneumonia. To date, this unique antibiotic exhibits a low propensity for inducing resistance and has a good safety profile, although further post-marketing data and clinical experience are needed. In summary, ceftaroline provides an additional option for the management of complex multidrug resistant infections, including MRSA.
微生物耐药性已达到惊人的程度,其发展速度可能超过研发更有效抗菌药物的能力。特别是,耐甲氧西林金黄色葡萄球菌(MRSA)已成为皮肤和软组织感染的主要原因,而产PVL毒素的菌株与坏死性肺炎有关。对糖肽类药物耐药性不断增加的报道日益增多,这进一步限制了万古霉素等标准抗生素的疗效。头孢洛林是一种新型的第五代头孢菌素,对革兰氏阳性菌具有广谱活性,包括MRSA以及广泛耐药菌株,如万古霉素中介金黄色葡萄球菌(VISA)、异质性VISA(hVISA)和耐万古霉素金黄色葡萄球菌(VRSA)。除了是抗MRSA药物库中的一种令人兴奋的新药外,头孢洛林对许多呼吸道病原体也有效,包括肺炎链球菌、流感嗜血杆菌和卡他莫拉菌。在治疗复杂性皮肤和软组织感染以及社区获得性肺炎的III期研究中,已证明头孢洛林(每12小时静脉注射600mg)有效。迄今为止,这种独特的抗生素诱导耐药的倾向较低,安全性良好,不过仍需要更多上市后数据和临床经验。总之,头孢洛林为包括MRSA在内的复杂多重耐药感染的治疗提供了一个额外的选择。