Gribble M J, Chow A W, Naiman S C, Smith J A, Bowie W R, Sacks S L, Grossman L, Buskard N, Growe G H, Plenderleith L H
Antimicrob Agents Chemother. 1983 Sep;24(3):388-93. doi: 10.1128/AAC.24.3.388.
Piperacillin as a single agent was compared in a prospective randomized trial with carboxypenicillin-aminoglycoside combinations in empirical therapy of serious bacterial infections. The difference in the clinical response rates with piperacillin (77% of 26 infection episodes) and combination therapy (75% of 24 infection episodes) were not statistically significant. Fewer adverse effects occurred in the piperacillin-treated group (42%) than in the combination-treated group (71%) (P = 0.0399 by Fisher's exact test), although neither nephrotoxicity nor hypokalemia alone was significantly less frequent in patients receiving piperacillin. However, the emergence of resistant organisms during therapy was more frequent among patients receiving piperacillin alone (42% of patients) than among patients receiving combination therapy (17% of patients) (P = 0.465 by Fisher's exact test). Moreover, emergence of resistance accounted for 5 of 9 patients with treatment failure, superinfection, or both when piperacillin was used as a single agent, compared with 2 of 10 similar patients in the combination group (P = 0.1299 by Fisher's exact test). The use of piperacillin as a single agent in the treatment of serious bacterial infections is not advocated, and the addition of an aminoglycoside to prevent emergence of resistance during empirical therapy of such infections is strongly recommended.
在一项前瞻性随机试验中，将哌拉西林单药治疗与羧苄青霉素 - 氨基糖苷类药物联合治疗用于严重细菌感染的经验性治疗进行了比较。哌拉西林治疗组（26例感染病例中的77%）和联合治疗组（24例感染病例中的75%）的临床有效率差异无统计学意义。哌拉西林治疗组（42%）出现的不良反应少于联合治疗组（71%）（Fisher精确检验，P = 0.0399），尽管单独使用哌拉西林的患者中肾毒性和低钾血症的发生率均未显著降低。然而，单独使用哌拉西林治疗的患者中，治疗期间耐药菌的出现频率（42%的患者）高于联合治疗组（17%的患者）（Fisher精确检验，P = 0.465）。此外，单独使用哌拉西林作为单一药物治疗时，9例治疗失败、发生二重感染或两者皆有的患者中有5例是由耐药菌出现所致，而联合治疗组10例类似患者中有2例（Fisher精确检验，P = 0.1299）。不提倡将哌拉西林单药用于治疗严重细菌感染，强烈建议在这类感染的经验性治疗中加用氨基糖苷类药物以防止耐药菌的出现。
