Stevens D L, Maier K A, Laine B M, Mitten J E
J Infect Dis. 1987 Feb;155(2):220-8. doi: 10.1093/infdis/155.2.220.
Gas gangrene caused by Clostridium perfringens is associated with significant mortality and morbidity in spite of penicillin treatment. Although prompt surgical debridement has been established as the primary therapeutic objective, additional studies are needed for determination of the optimal antimicrobial therapy. In a mouse model of gas gangrene caused by Clostridium perfringens, clindamycin, metronidazole, rifampin, and tetracycline were all more efficacious than penicillin (P less than .05). Survival of penicillin-treated mice was not significantly better than that of untreated controls in spite of serum levels that ranged up to 77-1,800 micrograms/ml. Responses to metronidazole were highly dose dependent. For example, 60% of mice survived after 75 mg of metronidazole/kg, but only 10% survived after 19 mg/kg. In contrast, clindamycin was highly effective over a broad dosing range (8.6-86 mg/kg). The efficacy of all antibiotics was reduced if treatment was delayed or larger inocula of bacteria were used.
尽管使用了青霉素治疗，产气荚膜梭菌引起的气性坏疽仍与显著的死亡率和发病率相关。虽然迅速进行外科清创已被确立为主要治疗目标，但仍需要进一步研究以确定最佳抗菌治疗方案。在产气荚膜梭菌引起的气性坏疽小鼠模型中，克林霉素、甲硝唑、利福平和四环素都比青霉素更有效（P小于0.05）。尽管青霉素治疗组小鼠的血清水平高达77 - 1800微克/毫升，但其存活率并不显著高于未治疗的对照组。甲硝唑的疗效高度依赖剂量。例如，75毫克/千克甲硝唑治疗后60%的小鼠存活，但19毫克/千克治疗后只有10%的小鼠存活。相比之下，克林霉素在较宽的剂量范围内（8.6 - 86毫克/千克）都非常有效。如果治疗延迟或使用更大剂量的细菌接种物，所有抗生素的疗效都会降低。
