Department of Urology, Pediatric Urology and Andrology, Justus-Liebig-University, Giessen, Germany.
Int J Antimicrob Agents. 2011 Dec;38 Suppl:3-10. doi: 10.1016/j.ijantimicag.2011.09.004. Epub 2011 Oct 20.
Urinary tract infections (UTIs) and male genital infections are amongst the most prevalent infections. A prudent antibiotic policy therefore has a large impact on society. The clinical classification in uncomplicated cystitis, uncomplicated pyelonephritis, complicated UTI and genital infections is useful, also for the right choice of antibiotic treatment. In this regard pharmacokinetic and pharmacodynamic aspects have to be considered. Nowadays in uncomplicated cystitis antibiotics exclusively reserved for this indication are preferred, such as fosfomycin trometamol, nitrofurantoin and pivmecillinam, in order to reduce antibiotic pressure in this extremely frequent entity. In complicated UTI a broad bacterial spectrum has to be considered. Different antibiotic substances should be used for treatment, such as penicillins, with β-lactamase inhibitors, cephalosporins or carbapenems, fluoroquinolones, aminoglycosides or cotrimoxazole, if tested susceptible. For genital infections the pharmacokinetic properties of the antibiotics should especially be considered, such as in prostatitis, where mainly fluoroquinolones and macrolides show sufficient pharmacokinetic parameters for treatment of bacterial infections. Furthermore in genital infections fastidious organisms, such as Chlamydia or Mycoplasma spp. have to be considered with respect to their antimicrobial susceptibility.
尿路感染（UTIs）和男性生殖器感染是最常见的感染之一。因此，谨慎的抗生素政策对社会有很大的影响。在单纯性膀胱炎、单纯性肾盂肾炎、复杂性尿路感染和生殖器感染的临床分类中，抗生素的选择具有重要意义。在这方面，需要考虑药代动力学和药效动力学方面。如今，在单纯性膀胱炎中，首选专门为此适应症保留的抗生素，如磷霉素氨丁三醇、呋喃妥因和匹美西林，以减少这种极其常见的疾病的抗生素压力。在复杂性尿路感染中，需要考虑广泛的细菌谱。不同的抗生素药物应根据药敏试验结果使用，如治疗用的青霉素类药物，与β-内酰胺酶抑制剂、头孢菌素或碳青霉烯类药物、氟喹诺酮类药物、氨基糖苷类药物或复方磺胺甲噁唑，如果测试结果敏感。对于生殖器感染，抗生素的药代动力学特性尤其需要考虑，例如在前列腺炎中，主要使用氟喹诺酮类药物和大环内酯类药物来治疗细菌感染，因为它们具有足够的药代动力学参数。此外，在生殖器感染中，还需要考虑到如衣原体或支原体等难以治疗的病原体，以评估其对抗菌药物的敏感性。
