Smith C R, Ambinder R, Lipsky J J, Petty B G, Israel E, Levitt R, Mellits E D, Rocco L, Longstreth J, Lietman P S
Ann Intern Med. 1984 Oct;101(4):469-77. doi: 10.7326/0003-4819-101-4-469.
In a prospective, randomized, double-blind study, we compared cefotaxime with nafcillin plus tobramycin in the treatment of serious bacterial infections. Of 195 patients with suspected or proven infections who were not neutropenic, definite bacterial infections were identified in 81; 34 of 38 patients given cefotaxime and 26 of 43 given nafcillin plus tobramycin (p less than 0.01) responded to treatment. The difference in response rates occurred primarily in patients with rapidly fatal underlying disease or with an infection outside the urinary tract. A logistic regression analysis showed that treatment with cefotaxime was still associated with a higher response rate after adjusting for several potential confounding factors. Among patients treated for 3 days or more, our criteria for nephrotoxicity were met in 2 of 68 (2.9%) given cefotaxime and 16 of 57 (28.1%) given nafcillin plus tobramycin (p less than 0.001). Prolongation of the prothrombin time and enterococcal colonization did not occur more frequently with cefotaxime. We conclude that cefotaxime may be more effective and less toxic than nafcillin plus tobramycin for patients with serious bacterial infections.
在一项前瞻性、随机、双盲研究中，我们比较了头孢噻肟与萘夫西林加妥布霉素治疗严重细菌感染的效果。在195例无中性粒细胞减少的疑似或确诊感染患者中，81例确诊为细菌感染；接受头孢噻肟治疗的38例患者中有34例、接受萘夫西林加妥布霉素治疗的43例患者中有26例对治疗有反应（p<0.01）。反应率的差异主要出现在患有快速致命性基础疾病或泌尿系统外感染的患者中。逻辑回归分析表明，在调整了几个潜在的混杂因素后，头孢噻肟治疗仍与较高的反应率相关。在治疗3天或更长时间的患者中，接受头孢噻肟治疗的68例中有2例（2.9%）、接受萘夫西林加妥布霉素治疗的57例中有16例（28.1%）符合我们的肾毒性标准（p<0.001）。头孢噻肟治疗时，凝血酶原时间延长和肠球菌定植的发生频率没有更高。我们得出结论，对于严重细菌感染患者，头孢噻肟可能比萘夫西林加妥布霉素更有效且毒性更小。
