Neu H C
Department of Medicine, College of Physicians & Surgeons, Columbia University, New York, New York 10032.
J Clin Pharmacol. 1990 May;30(5):396-403. doi: 10.1002/j.1552-4604.1990.tb03476.x.
Compared with aminoglycosides, chloramphenicol, sulfonamides, tetracyclines, and even penicillins, the cephalosporins represent a remarkably safe class of antibiotics. Among the cephalosporins, the extended spectrum, third generation agents developed generally produce few side effects and appear to be less allergenic than the penicillins. Nephrotoxicity has not been a problem at recommended doses. Some third generation agents can cause hypoprothrombinemia if not administered with vitamin K, and disulfiram-like reactions occur with some agents because of the presence of a thiomethyl tetruzole moiety affixed to the cephem nucleus. There is a greater incidence of diarrhea associated with the agents excreted through a primarily biliary route, and this may contribute to the selection of drug resistant bacteria. Some agents are less active against staphylococci and their use may result in an increased incidence of superinfection or overgrowth of enterococci. If attention is given to the potential for adverse effects, many of these problems can be avoided and the third generation cephalosporins can be used safely in hospitals, nursing homes, and home care settings.
与氨基糖苷类、氯霉素、磺胺类、四环素类甚至青霉素类相比，头孢菌素类是一类安全性非常高的抗生素。在头孢菌素类中，一般所研发的广谱第三代药物副作用很少，而且似乎比青霉素类的致敏性更低。在推荐剂量下，肾毒性并非问题。一些第三代药物如果不与维生素K一起使用，可能会导致低凝血酶原血症，并且由于头孢烯核上连接有硫代甲基四氮唑部分，一些药物会出现双硫仑样反应。主要通过胆汁途径排泄的药物所引起的腹泻发生率更高，这可能会促使耐药菌的产生。一些药物对葡萄球菌的活性较低，使用它们可能会导致二重感染或肠球菌过度生长的发生率增加。如果关注到这些潜在的不良反应，许多问题是可以避免的，第三代头孢菌素类药物可以在医院、疗养院和家庭护理环境中安全使用。
