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替莫西林:临床重新评估的叙述性综述

Temocillin: A Narrative Review of Its Clinical Reappraisal.

作者信息

Cosimi Lavinia, Zerbato Verena, Grasselli Kmet Nina, Oliva Alessandra, Cogliati Dezza Francesco, Geremia Nicholas, Cattaneo Dario, Nadrah Kristina, Pirs Mateja, Saletinger Rajko, Nunnari Alessio, Mearelli Filippo, Di Girolamo Filippo Giorgio, Avena Graziana, Russo Roberta, Fabiani Carolina, Venturini Sergio, Principe Luigi, Nicolò Giovanna Maria, Di Bella Stefano

机构信息

Infectious Diseases Unit, Trieste University Hospital (ASUGI), 34125 Trieste, Italy.

Infectious Diseases Department, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia.

出版信息

Antibiotics (Basel). 2025 Aug 26;14(9):859. doi: 10.3390/antibiotics14090859.

Abstract

The emergence of multidrug-resistant Gram-negative bacteria, particularly extended-spectrum β-lactamase (ESBL) and AmpC-producing , has brought renewed interest in temocillin, a narrow-spectrum β-lactam antibiotic first introduced in the 1980s. We aimed to provide a comprehensive overview of the microbiological, pharmacological, and clinical profile of temocillin. We conducted a narrative review of the literature using the PubMed database to identify relevant studies concerning the microbiology, pharmacokinetics, pharmacodynamics, clinical applications, and safety of temocillin. : Temocillin shows strong in vitro activity against ESBL- and AmpC-producing organisms, and partial efficacy against certain carbapenemase (KPC)-producing strains. Its pharmacokinetic and pharmacodynamic characteristics, including β-lactamase stability and low ecological impact, support its use in urinary tract infections, bloodstream infections, intra-abdominal infections, pneumonia, and central nervous system infections. Additionally, evidence supports its utility in outpatient parenteral antimicrobial therapy (OPAT), including subcutaneous administration, and in vulnerable populations such as pediatric, elderly, and immunocompromised patients. Temocillin demonstrates a favorable safety profile, minimal disruption of gut microbiota, and cost-effectiveness. It also exhibits synergistic activity with agents like fosfomycin, further enhancing its clinical value. Most of the current evidence is derived from retrospective and observational studies. Temocillin emerges as a promising carbapenem-sparing option for the treatment of challenging infections caused by multidrug-resistant Gram-negative bacteria.

摘要

多重耐药革兰氏阴性菌的出现,尤其是产超广谱β-内酰胺酶(ESBL)和AmpC酶的细菌,重新引发了人们对替莫西林的兴趣。替莫西林是一种窄谱β-内酰胺类抗生素,于20世纪80年代首次推出。我们旨在全面概述替莫西林的微生物学、药理学和临床概况。我们使用PubMed数据库对文献进行了叙述性综述,以确定有关替莫西林的微生物学、药代动力学、药效学、临床应用和安全性的相关研究。替莫西林对产ESBL和AmpC酶的微生物显示出强大的体外活性,对某些产碳青霉烯酶(KPC)的菌株有部分疗效。其药代动力学和药效学特性,包括β-内酰胺酶稳定性和低生态影响,支持其用于治疗尿路感染、血流感染、腹腔内感染、肺炎和中枢神经系统感染。此外,有证据支持其在门诊胃肠外抗菌治疗(OPAT)中的应用,包括皮下给药,以及在儿科、老年和免疫功能低下等弱势群体中的应用。替莫西林显示出良好的安全性、对肠道微生物群的干扰最小且具有成本效益。它还与磷霉素等药物表现出协同活性,进一步提高了其临床价值。目前的大多数证据来自回顾性和观察性研究。替莫西林是一种有前景的、可替代碳青霉烯类药物的选择,用于治疗由多重耐药革兰氏阴性菌引起的具有挑战性的感染。

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