Hedström S A
Scand J Infect Dis Suppl. 1984;42:135-42.
Beta-lactam antibiotics are highly effective against most bacteria causing skin and soft tissue infections. Good tissue penetration further makes beta-lactam antibiotics useful against skin and soft tissue infections. Drugs with a narrow spectrum should be among the first choice. Broader spectrum beta-lactam antibiotics may be needed in reduced bacterial susceptibility. Low molecular weight compounds (monobactams, penems, penicillinase inhibitors) in addition to their high antibacterial effect have shown excellent tissue penetration. In easy and moderately severe anaerobic infections not treatable with conventional oral beta-lactam antibiotics, other oral antibacterial agents (e.g. clindamycin, metronidazole) may be used rather than the parenteral recent acyl-ureidopenicillins or cephalosporins. Due to long duration of skin and soft tissue levels of drugs, it is unnecessary to administer beta-lactam antibiotics more than 2 or 3 times a day. Normal dosage schedules can be employed except in severely compromised elimination when decreased doses may be recommended or in immuno-compromised hosts and other risk patients who may require a 2- or 3-fold increase.
β-内酰胺类抗生素对大多数引起皮肤和软组织感染的细菌具有高度有效性。良好的组织穿透性进一步使β-内酰胺类抗生素对皮肤和软组织感染有效。窄谱药物应作为首选。在细菌敏感性降低时，可能需要使用广谱β-内酰胺类抗生素。低分子量化合物（单环β-内酰胺类、青霉烯类、青霉素酶抑制剂）除具有高抗菌作用外，还显示出优异的组织穿透性。在不能用传统口服β-内酰胺类抗生素治疗的轻度和中度严重厌氧感染中，可使用其他口服抗菌剂（如克林霉素、甲硝唑），而不是胃肠外新型酰脲类青霉素或头孢菌素。由于药物在皮肤和软组织中的浓度持续时间长，每天给予β-内酰胺类抗生素超过2或3次是不必要的。除了在严重损害清除功能时可能建议减少剂量，或在免疫功能低下的宿主和其他可能需要增加2或3倍剂量的高危患者中，可采用常规剂量方案。
