Giamarellou H
1st Department of Propedeutic Medicine, Athens University School of Medicine, Laiko General Hospital, Greece.
J Antimicrob Chemother. 1993 Nov;32 Suppl B:123-32. doi: 10.1093/jac/32.suppl_b.123.
Since infection develops in significant numbers of hospitalized patients, the problem of resistance to third-generation cephalosporins is of increasing concern. We evaluated the efficacy of cefepime 1 g bd as treatment for acute, moderately severe bacterial infection in 239 hospitalized patients (mean age 60 years). Of these patients, 204 were evaluated clinically for urinary tract infection (UTI) (n = 90), lower respiratory tract infection (LRTI) (n = 70), skin and soft tissue infection (S/STI) (n = 12) and bacteraemia which was associated with either UTI or LRTI (n = 32) but not included in the previously mentioned UTI and LRTI groups. Amongst the pathogens isolated (36 Gram-positive, 150 Gram-negative), the most predominant species were Escherichia coli in UTI and bacteraemia (n = 81), Streptococcus pneumoniae in LRTI and bacteraemia (n = 23), Haemophilus influenzae in LRTI (n = 16), Pseudomonas aeruginosa (n = 4) and Enterobacter cloacae (n = 2) in S/STI. The mean duration of treatment was 8.5 days and was the same for the 204 clinically evaluable patients. Overall, the clinical cure rate for cefepime was 94% (191/204). Pathogen eradication was achieved in 93% (185/199) of infections. Of the patients with associated bacteraemia, the clinical cure rate was 97% (31/32) and 94% (16/17) of the pathogens were eradicated. Cefepime therapy was well-tolerated. Treatment was discontinued in eight patients (3%) because of local intolerance and in five patients (2%) because of drug-related adverse events (rash, headache and pruritus). Cefepime 1 g bd is as safe and effective as other parenteral cephalosporins for the treatment of acute bacterial UTI, LRTI and S/STI, including those cases with associated bacteraemia. The bd dosing schedule and reported lack of cross-resistance with other cephalosporins against some species of aerobic Gram-negative bacilli make cefepime an attractive treatment option in hospitalized patients.
由于大量住院患者会发生感染，对第三代头孢菌素的耐药问题日益受到关注。我们评估了每日两次静脉滴注1克头孢吡肟治疗239例住院患者（平均年龄60岁）急性、中度严重细菌感染的疗效。在这些患者中，204例接受了临床评估，涉及尿路感染（UTI）（90例）、下呼吸道感染（LRTI）（70例）、皮肤及软组织感染（S/STI）（12例）以及与UTI或LRTI相关的菌血症（32例），但不包括前述UTI和LRTI组中的病例。在分离出的病原体中（36株革兰阳性菌、150株革兰阴性菌），最主要的菌种为UTI和菌血症中的大肠杆菌（81例）、LRTI和菌血症中的肺炎链球菌（23例）、LRTI中的流感嗜血杆菌（16例）、S/STI中的铜绿假单胞菌（4例）和阴沟肠杆菌（2例）。平均治疗疗程为8.5天，204例可进行临床评估的患者疗程相同。总体而言，头孢吡肟的临床治愈率为94%（191/204）。93%（185/199）的感染实现了病原体清除。在伴有菌血症的患者中，临床治愈率为97%（(31/32），94%（16/17）的病原体被清除。头孢吡肟治疗耐受性良好。8例患者（3%）因局部不耐受停药，5例患者（2%）因药物相关不良事件（皮疹、头痛和瘙痒）停药。每日两次静脉滴注1克头孢吡肟治疗急性细菌性UTI、LRTI和S/STI，包括伴有菌血症的病例，与其他肠外头孢菌素一样安全有效。每日两次给药方案以及报道的与其他头孢菌素对某些需氧革兰阴性杆菌菌种不存在交叉耐药性，使头孢吡肟成为住院患者有吸引力的治疗选择。
