Dejace P, Klastersky J
Service de Médecine et Laboratoire d'Investigation Clinique, Université Libre de Bruxelles.
Infection. 1987;15 Suppl 4:S158-67. doi: 10.1007/BF01645863.
We have reviewed the available literature on the controlled use of combinations of beta-lactams in the treatment of fever in neutropenic patients, as compared to that of combinations of beta-lactams and aminoglycosides. We compared overall responses, responses in septicemia and various other infections, according to different pathogens and degree of neutropenia, and we evaluated toxicity. Overall, these results showed that response rates with combinations of two beta-lactams are similar to those obtained with combinations of a beta-lactam and an aminoglycoside for infections in immunocompromised patients with serious underlying diseases. They also suggest that the emergence of resistance of pathogens to beta-lactams has often been coped by the use of newer drugs in infections caused by Enterobacteriaceae, but much less effectively in the case of Pseudomonas aeruginosa infections. There are still other important theoretical reasons for preferring an aminoglycoside-containing combination for empiric therapy in febrile neutropenic patients, and our overall conclusion is that a large-scale study comparing beta-lactam combinations to the traditional beta-lactam plus aminoglycoside regimens is mandatory.
我们回顾了关于在中性粒细胞减少患者发热治疗中，β-内酰胺类药物联合使用与β-内酰胺类药物和氨基糖苷类药物联合使用相比的现有文献。我们根据不同病原体和中性粒细胞减少程度，比较了总体反应、败血症及其他各种感染中的反应，并评估了毒性。总体而言，这些结果表明，对于患有严重基础疾病的免疫功能低下患者的感染，两种β-内酰胺类药物联合使用的反应率与β-内酰胺类药物和氨基糖苷类药物联合使用的反应率相似。这些结果还表明，在肠杆菌科细菌引起的感染中，病原体对β-内酰胺类药物耐药性的出现常常通过使用新型药物来应对，但在铜绿假单胞菌感染的情况下效果要差得多。在发热性中性粒细胞减少患者的经验性治疗中，仍有其他重要的理论原因支持使用含氨基糖苷类药物的联合方案，我们的总体结论是，必须进行一项大规模研究，将β-内酰胺类药物联合方案与传统的β-内酰胺类药物加氨基糖苷类药物方案进行比较。
