Smith C C
Department of Medicine, Aberdeen Royal Infirmary, Scotland.
Intensive Care Med. 1990;16 Suppl 3(Suppl 3):S243-7. doi: 10.1007/BF01709709.
The management of severe bacterial sepsis is an integral part of intensive care medicine. Early and appropriate treatment with antimicrobials positively affects mortality and significantly reduces the time spent in both intensive care and the hospital. Drug choice is usually made on a "best guess" basis and instituted prior to receipt of appropriate blood, sputum, urine or drainage culture results. Bactericidal drugs should be given in combination, delivered by intravenous bolus and directed towards broad cover of all likely pathogens. Aminoglycoside/ureidopenicillin combinations are synergistic and widely used--often combined with metronidazole. Aminoglycoside toxicity can be reduced by giving the drug once daily (OD) rather than by traditional multiple daily dosing (MDD) and by measuring peak and trough serum levels. Efficacy is increased by attention to the peak serum level/MIC ratio which determines the response to treatment. Several newer agents have been more recently introduced. These drugs include ceftazidime, imipenem/cilastatin, the quinolones and clavulanic acid/semisynthetic penicillin combinations. Other newer drugs currently under evaluation include aztreonam, teicoplanin, the penems and carbapenems.
严重细菌性脓毒症的管理是重症监护医学不可或缺的一部分。早期且恰当的抗菌药物治疗对死亡率有积极影响，并显著缩短在重症监护病房和医院的住院时间。药物选择通常基于“最佳猜测”，并在获得合适的血液、痰液、尿液或引流液培养结果之前就开始使用。应联合使用杀菌药物，通过静脉推注给药，针对所有可能的病原体进行广泛覆盖。氨基糖苷类/脲基青霉素联合用药具有协同作用且广泛应用，常与甲硝唑联合使用。通过每日一次给药而非传统的每日多次给药，并监测血清峰浓度和谷浓度，可以降低氨基糖苷类药物的毒性。关注血清峰浓度/MIC比值可提高疗效，该比值决定治疗反应。最近引入了几种新型药物。这些药物包括头孢他啶、亚胺培南/西司他丁、喹诺酮类以及克拉维酸/半合成青霉素联合制剂。目前正在评估的其他新型药物包括氨曲南、替考拉宁、青霉烯类和碳青霉烯类。
