Krcméry V
Department of Medicine, Postgraduate Medical School, University of Trnava, Slovak Republic.
Drugs. 1995;49 Suppl 2:139-43. doi: 10.2165/00003495-199500492-00023.
Quinolones are valuable antimicrobial agents for prevention and therapy of febrile neutropenia. However, as with other groups of antibacterials, there are limitations to the use of quinolones in immunocompromised hosts: they should not be used in those neutropenic patients receiving ciprofloxacin or ofloxacin for prophylaxis, because of the risk of infection with resistant Gram-negative, or less susceptible Gram-positive, organisms. There are also insufficient data to support monotherapy of febrile neutropenia with quinolones, although some studies using higher ciprofloxacin dosages have reported encouraging results. More data on this issue, including use in paediatric cancer patients, are required. Quinolones are indicated for empirical therapy in combination with agents active against Gram-positive organisms, such as broad spectrum penicillins with or without beta-lactamase inhibitors, or in combination with vancomycin or teicoplanin. Some studies have shown that a combination of cefotaxime or ceftriaxone may provide better coverage against streptococci, but there are insufficient data on the combination of quinolones with third generation cephalosporins. A specific group of patients with low risk mild to moderate neutropenia with solid tumours may benefit from oral therapy with quinolones in combination with either an aminopenicillin with a beta-lactamase inhibitor or clindamycin. After 10 years of quinolone use in febrile neutropenia, these agents can still be regarded as valuable drugs of choice; however, the incidence of resistance among staphylococci and Pseudomonas spp., especially in centres using quinolones as prophylaxis, is increasing.
喹诺酮类药物是预防和治疗发热性中性粒细胞减少症的重要抗菌药物。然而，与其他抗菌药物类别一样，喹诺酮类药物在免疫功能低下宿主中的使用存在局限性：对于正在接受环丙沙星或氧氟沙星预防治疗的中性粒细胞减少患者，不应使用喹诺酮类药物，因为存在感染耐革兰氏阴性菌或较不敏感革兰氏阳性菌的风险。目前也没有足够的数据支持用喹诺酮类药物单药治疗发热性中性粒细胞减少症，尽管一些使用较高剂量环丙沙星的研究报告了令人鼓舞的结果。需要更多关于这个问题的数据，包括在儿科癌症患者中的使用情况。喹诺酮类药物适用于与抗革兰氏阳性菌的药物联合进行经验性治疗，例如加或不加β-内酰胺酶抑制剂的广谱青霉素，或与万古霉素或替考拉宁联合使用。一些研究表明，头孢噻肟或头孢曲松联合使用可能对链球菌有更好的覆盖，但关于喹诺酮类药物与第三代头孢菌素联合使用的数据不足。一组患有实体瘤且轻度至中度中性粒细胞减少风险较低的特定患者，可能从喹诺酮类药物与氨基青霉素加β-内酰胺酶抑制剂或克林霉素联合的口服治疗中获益。在发热性中性粒细胞减少症中使用喹诺酮类药物10年后，这些药物仍可被视为有价值的首选药物；然而，葡萄球菌和假单胞菌属的耐药率正在上升，尤其是在将喹诺酮类药物用作预防药物的中心。
