York Joshua A, Varadarajan Maithili, Barlow Gavin
Hull York Medical School, York, UK.
Department of Infection, Hull University Teaching Hospitals, Hull, UK.
Br J Hosp Med (Lond). 2020 Feb 2;81(2):1-9. doi: 10.12968/hmed.2019.0348. Epub 2020 Feb 25.
Antimicrobial resistance is a global crisis. Prescribing antibacterial combinations may be one way of reducing the development of resistance in target pathogens, as in the treatment of tuberculosis. Combinations may be useful for ascertaining synergy, broadening antimicrobial cover to reduce the risk of non-susceptibility, antimicrobial stewardship reasons, and immune modulation. The current research literature and/or prevailing global standards of clinical care suggest that combination therapy may be advantageous in: severe community-acquired pneumonia; severe hospital-acquired or ventilator-associated pneumonia or when there is a high risk of resistance in hospital-acquired or ventilator-associated pneumonia; multi-drug or extensively drug-resistant Gram-negative infections; and severe group A streptococcal infections. In other situations, combinations may be harmful. Overall, outside of tuberculosis, combination antibacterial therapy is likely to improve outcomes only in specific circumstances and there is little evidence to suggest that this prevents the development of bacterial resistance. Further high-quality research is essential.
抗菌药物耐药性是一场全球危机。开具抗菌药物联合处方可能是减少目标病原体耐药性产生的一种方法，如在结核病治疗中。联合用药可能有助于确定协同作用、扩大抗菌谱以降低不敏感风险、基于抗菌药物管理的原因以及免疫调节。当前的研究文献和/或现行的全球临床护理标准表明，联合治疗在以下情况可能具有优势：重症社区获得性肺炎；重症医院获得性或呼吸机相关性肺炎，或医院获得性或呼吸机相关性肺炎存在高耐药风险时；多重耐药或广泛耐药革兰氏阴性菌感染；以及重症A组链球菌感染。在其他情况下，联合用药可能有害。总体而言，除结核病外，联合抗菌治疗可能仅在特定情况下改善疗效，几乎没有证据表明这能预防细菌耐药性的产生。进一步开展高质量研究至关重要。
