Olarte-Luis Tatiana, Cáceres-Galíndez Dolli, Cortés Jorge Alberto
Departamento de Medicina Interna, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia.
Rev Chilena Infectol. 2018;35(5):465-475. doi: 10.4067/s0716-10182018000500465.
Bacterial resistance has increased in Latin America and the world, making research and creation of new antimicrobials capable of eradicating resistant microorganisms essential. A review of new cephalosporins and their combinations with a beta-lactamase inhibitor was conducted, collecting data on the spectrum, pharmacokinetic and pharmacodynamic profile and clinical studies of the current indications for ceftaroline, and the combinations ceftazidime with avibactam and ceftolozane with tazobactam. The first one has activity against methicillin-resistant Staphylococcus aureus and coagulase negative Staphylococcus (SCoN) and against penicillin-resistant Streptococcus pneumoniae, therefore approved for use in community-acquired pneumonia and acute bacterial skin and skin structure infections. Among the new combinations, ceftazidime, a third generation cephalosporin with antipseudomonal activity, associated with avibactam, a betalactamase inhibitor, has been shown to be effective in the treatment of abdominal infections and complicated urinary infections. Finally, the combination of ceftolozane with tazobactam has comparable action to ceftazidime with avibactam due to its activity against Gram negative rods, and in combination with metronidazole they do not present inferiority to meropenem in intra-abdominal infections. The clinical studies are presented, as well as the potential indications and clinical scenarios for their use of this cephalosporins.
在拉丁美洲乃至全球，细菌耐药性都有所增加，因此研发能够根除耐药微生物的新型抗菌药物至关重要。本文对新型头孢菌素及其与β-内酰胺酶抑制剂的联合用药进行了综述，收集了头孢洛林以及头孢他啶与阿维巴坦、头孢托罗与他唑巴坦联合用药的抗菌谱、药代动力学和药效学特征以及当前适应证的临床研究数据。头孢洛林对耐甲氧西林金黄色葡萄球菌和凝固酶阴性葡萄球菌以及耐青霉素肺炎链球菌具有活性，因此被批准用于社区获得性肺炎和急性细菌性皮肤及皮肤结构感染。在新型联合用药中，具有抗假单胞菌活性的第三代头孢菌素头孢他啶与β-内酰胺酶抑制剂阿维巴坦联合使用，已被证明可有效治疗腹腔感染和复杂性尿路感染。最后，头孢托罗与他唑巴坦联合用药对革兰氏阴性菌有活性，其作用与头孢他啶和阿维巴坦相当，并且在腹腔感染中与甲硝唑联合使用时，并不比美罗培南差。本文介绍了这些头孢菌素的临床研究以及它们的潜在适应证和临床应用场景。
