Holloway W J, Palmer D
Medical Center of Delaware, Wilmington, Delaware 19899, USA.
Am J Med. 1996 Jun 24;100(6A):52S-59S. doi: 10.1016/s0002-9343(96)00108-8.
Cephalosporins are one of the mainstays of antibiotic therapy, and third-generation cephalosporins are first-line agents for the treatment of many types of serious infections, including those of nosocomial origin. Gaps in activity of currently available third-generation cephalosporins such as cefotaxime, cefoperazone, ceftriaxone, and ceftazidime, and increasing reports of gram-negative bacilli resistance to some of these agents, especially Klebsiella pneumoniae, Pseudomonas aeruginosa, and Enterobacter spp., make it necessary to investigate new compounds. Cefepime, a fourth-generation cephalosporin with a wide range of activity against gram-positive and gram-negative bacteria, including multi-resistant strains of Enterobacteriaceae, was evaluated in comparison with ceftazidime for the treatment of serious infections in hospitalized patients. Ceftazidime is a commonly prescribed third-generation cephalosporin used for empiric treatment of serious infections such as pneumonia, urinary tract infection, and skin and skin-structure infection. This investigation was an open, randomized comparative study involving 882 patients in North America. Cefepime 2 g every 12 hours demonstrated similar efficacy to that of ceftazidime 2 g every 8 hours for the treatment of pneumonia and urinary tract infection (including cases associated with concurrent bacteremia), and skin and skin-structure infections. The bacteriologic responses were generally >85%. The most common pathogens isolated were Escherichia coll, Streptococcus pneumoniae, P. aeruginosa, K. pneumoniae, Haemophilus influenzae, Staphylococcus aureus, and Streptococcus, group B. Overall, approximately 94% of pathogens isolated in pretreatment cultures were susceptible to cefepime and ceftazidime. Cefepime and ceftazidime were well tolerated; only 3% of patients in each group discontinued therapy because of an adverse event. The most common adverse events were headache, diarrhea, nausea, vomiting, pruritus, and rash. The results of this study indicate that cefepime is a promising, effective, and safe single-agent therapy for serious infections in hospitalized patients.
头孢菌素是抗生素治疗的主要药物之一，第三代头孢菌素是治疗多种严重感染的一线药物，包括医院获得性感染。目前可用的第三代头孢菌素（如头孢噻肟、头孢哌酮、头孢曲松和头孢他啶）存在活性差距，且革兰氏阴性杆菌对其中一些药物（尤其是肺炎克雷伯菌、铜绿假单胞菌和肠杆菌属）的耐药报告不断增加，因此有必要研究新的化合物。头孢吡肟是一种第四代头孢菌素，对革兰氏阳性和革兰氏阴性细菌具有广泛活性，包括产超广谱β-内酰胺酶的肠杆菌科细菌多重耐药菌株，本研究将其与头孢他啶进行比较，用于治疗住院患者的严重感染。头孢他啶是一种常用的第三代头孢菌素，用于经验性治疗严重感染，如肺炎、尿路感染以及皮肤和皮肤结构感染。本研究是一项开放性随机对照研究，涉及北美地区的882例患者。每12小时静脉滴注2g头孢吡肟治疗肺炎、尿路感染（包括合并菌血症的病例）以及皮肤和皮肤结构感染，其疗效与每8小时静脉滴注2g头孢他啶相似。细菌学反应率一般>85%。分离出的最常见病原体为大肠埃希菌、肺炎链球菌、铜绿假单胞菌、肺炎克雷伯菌、流感嗜血杆菌、金黄色葡萄球菌和B组链球菌。总体而言，治疗前培养分离出的病原体中约94%对头孢吡肟和头孢他啶敏感。头孢吡肟和头孢他啶耐受性良好；每组仅3%的患者因不良事件停药。最常见的不良事件为头痛、腹泻、恶心、呕吐、瘙痒和皮疹。本研究结果表明，头孢吡肟是一种有前景、有效且安全的单药治疗住院患者严重感染的药物。
