Gribble M J
Department of Medicine, University of British Columbia, Vancouver.
CMAJ. 1994 Sep 1;151(5):537-42.
To offer guidelines for the use of cefotetan, a cephamycin antibiotic, in order to minimize its overprescription.
Clinical practice options considered were treatment of infections with the use of second- and third-generation cephalosporins, carbapenems such as imipenem as well as combination regimens of agents active against anaerobic bacteria, such as metronidazole or clindamycin with an aminoglycoside.
In order of importance: efficacy, side effects and cost.
A MEDLINE search of articles published between January 1982 and December 1993. In-vitro and pharmacokinetic studies published in recognized peer-reviewed journals that used recognized standard methods with appropriate controls were reviewed. For results of clinical trials, the reviewers emphasized randomized double-blind trials with appropriate controls.
The Antimicrobial Agents Committee of the Canadian Infectious Disease Society (CIDS) and a recognized expert (M.J.G.) recommended use of cefotetan to prevent and treat infections against which it has proved effective in randomized controlled trials.
BENEFITS, HARMS AND COSTS: These guidelines should lead to less inappropriate prescribing of cefotetan, with its attendant costs and risk of development of resistant bacteria.
Cefotetan could be considered an alternative single agent for prophylaxis of infection in patients undergoing elective bowel surgery. It may be used to treat patients with acute pelvic inflammatory disease and endometritis.
This article was prepared, reviewed and revised by the Committee on Antimicrobial Agents of the CIDS. It was then reviewed by the Council of the CIDS, and any further necessary revisions were made by the chairman of the committee.
提供头霉素类抗生素头孢替坦的使用指南，以尽量减少其过度处方。
考虑的临床实践选项包括使用第二代和第三代头孢菌素治疗感染、使用亚胺培南等碳青霉烯类药物以及针对厌氧菌的活性药物联合方案，如甲硝唑或克林霉素与氨基糖苷类药物联合使用。
按重要性排序：疗效、副作用和成本。
对1982年1月至1993年12月发表的文章进行MEDLINE检索。对发表在公认的同行评审期刊上、采用公认标准方法并设有适当对照的体外和药代动力学研究进行了综述。对于临床试验结果，评审人员强调了设有适当对照的随机双盲试验。
加拿大传染病协会（CIDS）抗菌药物委员会和一位知名专家（M.J.G.）建议使用头孢替坦预防和治疗在随机对照试验中已证明有效的感染。
益处、危害和成本：这些指南应能减少头孢替坦的不适当处方及其随之而来的成本和耐药菌产生风险。
头孢替坦可被视为择期肠道手术患者预防感染的替代单一药物。它可用于治疗急性盆腔炎和子宫内膜炎患者。
本文由CIDS抗菌药物委员会编写、评审和修订。然后由CIDS理事会进行评审，委员会主席进行任何必要的进一步修订。
