Department of Microbiology, Sunderland Royal Hospital, Kayll Road, Sunderland SR4 7TP, UK.
J Antimicrob Chemother. 2014 Feb;69(2):303-8. doi: 10.1093/jac/dkt368. Epub 2013 Sep 25.
The continuing spread of resistant Gram-negative bacteria is a therapeutic challenge and prudent use of antimicrobials is therefore essential. Urinary tract infections (UTIs), usually due to Gram-negative bacteria, are among the most common infections seen in the community. Moreover, bacterial strains producing extended-spectrum β-lactamases (ESBLs) that are resistant not only to cephalosporins and penicillins, but also to fluoroquinolones and trimethoprim, are becoming more prevalent in the community. This means that oral antibiotic options to treat these infections are limited. The discovery of new drugs to tackle these problems has been difficult and slow paced; it is therefore timely to 'rediscover' the current antibiotics we have available in our clinical formulary, to determine how best they can be used. Pivmecillinam is an oral antibiotic with excellent clinical efficacy in the treatment of uncomplicated UTIs. It has been used extensively in Nordic countries with few problems, but, despite this, it is not widely used in other countries. There is emerging in vitro and in vivo evidence of its activity against ESBL-producing organisms and its synergistic potential with β-lactamase inhibitors. Pivmecillinam is well tolerated with a low side-effect profile. Pivmecillinam also has a minimal effect on the intestinal and vaginal flora of the host; thus, there is a lower rate of selection of resistant bacteria, vaginal candidiasis and, of note, Clostridium difficile.
耐药革兰氏阴性菌的持续传播是一个治疗挑战，因此谨慎使用抗生素至关重要。尿路感染（UTIs）通常由革兰氏阴性菌引起，是社区中最常见的感染之一。此外，产生扩展谱β-内酰胺酶（ESBLs）的细菌菌株不仅对头孢菌素和青霉素耐药，而且对氟喹诺酮类和甲氧苄啶耐药，在社区中越来越普遍。这意味着治疗这些感染的口服抗生素选择有限。发现新的药物来解决这些问题一直很困难且进展缓慢；因此，及时“重新发现”我们临床处方中现有的抗生素，以确定如何最好地使用它们是很重要的。匹美西林是一种治疗单纯性尿路感染具有极好临床疗效的口服抗生素。它在北欧国家被广泛使用，几乎没有问题，但尽管如此，它在其他国家并没有被广泛使用。越来越多的体外和体内证据表明它对产 ESBL 生物体具有活性，并且与β-内酰胺酶抑制剂具有协同作用。匹美西林具有良好的耐受性，副作用发生率低。匹美西林对宿主的肠道和阴道菌群也几乎没有影响；因此，耐药菌、阴道念珠菌的选择率较低，值得注意的是，艰难梭菌的选择率也较低。
