Quintiliani R
Scand J Infect Dis Suppl. 1984;42:99-109.
Any new antibiotic must be compared with older agents with respect to therapeutic efficacy, protection against infection, toxicity, cost and pharmacokinetic properties. For a new drug to be considered an "advance", it should achieve some definite advantage in one or more of these areas. By expanding their microbiologic activity and by killing many organisms at extremely low concentration, a number of new beta-lactam antibiotics have become useful agents in the therapy of difficult infections, particularly those occurring in patients with generalized immunodeficiencies or those occurring in body sites of localized immunodeficiency. Of additional clinical relevance has been the ability of some of these new drugs to replace the necessity of combination antibiotic therapy, reducing the chances for adverse reactions. To use the new beta-lactam antibiotics properly, one must now know much more than whether an organism is merely resistant or sensitive to the drug. One must know how sensitive and how resistant the bacterium is to the drug and for how long do serum and tissue levels remain above inhibitory or bactericidal concentrations of the drug for the suspected or proven pathogen. Of course, we cannot forget the cost of the drug and its potential for adverse reactions. In brief to prevent or to treat infections, the clinicians must be familiar with the microbiology, pharmacology, toxicology and cost of antibiotics.
任何一种新型抗生素都必须在治疗效果、抗感染能力、毒性、成本和药代动力学特性等方面与旧有药物进行比较。一种新药若要被视为“进步”，就应该在这些方面中的一个或多个方面取得某些明确的优势。通过扩大其微生物活性并在极低浓度下杀死多种微生物，一些新型β-内酰胺类抗生素已成为治疗难治性感染的有用药物，尤其是那些发生在全身性免疫缺陷患者身上的感染或发生在局部免疫缺陷身体部位的感染。这些新药中的一些能够取代联合抗生素治疗的必要性，从而减少不良反应发生几率，这一点在临床上也具有重要意义。要正确使用新型β-内酰胺类抗生素，现在必须了解的远远不止一种微生物对该药物仅仅是耐药还是敏感。必须知道细菌对该药物有多敏感和多耐药，以及血清和组织水平在多长时间内保持高于针对可疑或已证实病原体的药物抑制或杀菌浓度。当然，我们不能忘记药物的成本及其产生不良反应的可能性。简而言之，为了预防或治疗感染，临床医生必须熟悉抗生素的微生物学、药理学、毒理学和成本。
