Wilson C B, Jacobs R F, Smith A L
Semin Perinatol. 1982 Apr;6(2):205-13.
Many perinatal pathogens are able to survive and in some cases replicate intracellularly. With the exception of viruses and toxoplasma, these pathogens principally infect phagocytic cells of the reticuloendothelial system. Such intracellular organisms, by evading the effects of antibiotics that act only extracellularly, may respond poorly to conventional therapy. Of currently available antibiotics, rifampin, chloramphenicol and trimethoprim are the most active intracellularly. Other antibiotics are either taken up by cells but appear to be inactive intracellularly (lincomycin) or are excluded from cells (penicillins, cephalosporins, aminoglycosides). The clinical role of antibiotics that are active intracellularly is not clear; anecdotal human experience and limited controlled animal experience suggests that they may be useful in the treatment of some infections. Because of the decreased microbicidal activity of newborn phagocytes, intracellular activity of antibiotics may be of greater importance than in older patients. Further study is needed to answer these questions. Methods of enhancing intracellular activity of antibiotics are available should this property prove to be desirable.
许多围产期病原体能够存活，在某些情况下还能在细胞内复制。除病毒和弓形虫外，这些病原体主要感染网状内皮系统的吞噬细胞。这类细胞内病原体通过逃避仅在细胞外起作用的抗生素的影响，可能对传统治疗反应不佳。在目前可用的抗生素中，利福平、氯霉素和甲氧苄啶在细胞内的活性最强。其他抗生素要么被细胞摄取但在细胞内似乎无活性（林可霉素），要么被细胞排斥（青霉素、头孢菌素、氨基糖苷类）。细胞内有活性的抗生素的临床作用尚不清楚；零星的人体经验和有限的对照动物实验表明，它们可能对某些感染的治疗有用。由于新生儿吞噬细胞的杀菌活性降低，抗生素的细胞内活性可能比老年患者更为重要。需要进一步研究来回答这些问题。如果证明这种特性是可取的，就有增强抗生素细胞内活性的方法。
