Dinsmoor M J, Gibbs R S
Department of Obstetrics and Gynecology, University of Texas Health Science Center, San Antonio 78284.
Clin Obstet Gynecol. 1988 Jun;31(2):423-34. doi: 10.1097/00003081-198806000-00017.
The new antibiotics include interesting compounds--extended-spectrum cephalosporins and penicillins, combinations of older antibiotics plus beta-lactamase inhibitors, and new classes such as the monobactams and fluoroquinolones. In addition to extended spectrums, some of these compounds offer more favorable kinetics, less toxicity, or decreased cost. Several general conclusions might help place this array of new antibiotics in a useful clinical perspective. The newer antibiotics discussed here are no more effective than what is currently used. However, several have very good in-vitro activity against pelvic pathogens and are reasonable single-agent therapy in mild to moderate postpartum and postoperative infections. These antibiotics include cefoxitin, cefotetan, and piperacillin. Although moxalactam has good activity, its use is limited by concerns regarding bleeding disorders. Cefotaxime and cefoperazone have somewhat less favorable spectra, especially against anaerobes, yet in limited clinical trials are as effective as those cited above. Penicillin/beta-lactamase inhibitor combinations are currently being evaluated and appear to be reasonable choices. Although imipenem has an excellent in-vitro spectrum, it should probably be reserved for resistant cases. Aztreonam offers an alternative to gentamicin. However, in view of its greater cost, its use should be limited to patients in whom renal toxicity is a concern. For serious infections, combination therapy with clindamycin and gentamicin is our preference. For pelvic inflammatory disease, none of the agents is recommended as sole therapy due to the lack of coverage for chlamydia and frequent suboptimal coverage for anaerobes. Many of these agents have been effective for prophylaxis, but none has been shown to be superior to the older, less expensive agents such as cefazolin. Although many are effective in single doses, it is also likely that cefazolin is equally effective as a single dose. In addition, while most of the newer antibiotics are resistant to beta-lactamases themselves, they may induce their formation. This may ultimately result in limitations to the use of the relatively inexpensive prophylactic antibiotics.
新型抗生素包括一些有趣的化合物，如广谱头孢菌素和青霉素、老一代抗生素与β-内酰胺酶抑制剂的组合，以及新的类别，如单环β-内酰胺类抗生素和氟喹诺酮类抗生素。除了更广的抗菌谱外，其中一些化合物还具有更有利的药代动力学特性、更低的毒性或更低的成本。几个一般性结论可能有助于从实用的临床角度看待这一系列新型抗生素。这里讨论的新型抗生素并不比目前使用的抗生素更有效。然而，有几种对盆腔病原体具有很好的体外活性，是轻至中度产后和术后感染合理的单药治疗药物。这些抗生素包括头孢西丁、头孢替坦和哌拉西林。虽然拉氧头孢具有良好的活性，但由于对出血性疾病的担忧，其使用受到限制。头孢噻肟和头孢哌酮的抗菌谱稍差，尤其是对厌氧菌，但在有限的临床试验中与上述药物效果相当。青霉素/β-内酰胺酶抑制剂组合目前正在评估中，似乎是合理的选择。虽然亚胺培南具有出色的体外抗菌谱，但可能应保留用于耐药病例。氨曲南可作为庆大霉素的替代药物。然而，鉴于其成本较高，其使用应限于关注肾毒性的患者。对于严重感染，我们更倾向于克林霉素和庆大霉素联合治疗。对于盆腔炎，由于对衣原体缺乏覆盖且对厌氧菌的覆盖常常不理想，没有一种药物被推荐作为单一疗法。这些药物中的许多对预防有效，但没有一种被证明优于老一代、成本较低的药物，如头孢唑林。虽然许多药物单剂量有效，但头孢唑林单剂量可能同样有效。此外，虽然大多数新型抗生素本身对β-内酰胺酶有抗性，但它们可能诱导其形成。这最终可能导致相对便宜的预防性抗生素的使用受到限制。
