Rybak M J, McGrath B J
Department of Pharmacy, Detroit Receiving Hospital, Michigan, USA.
Drugs. 1996 Sep;52(3):390-405. doi: 10.2165/00003495-199652030-00005.
Therapy with antimicrobial combinations has been used as long as antimicrobials have been available. Combinations of antibiotics are often used to take advantage of different mechanisms of action and/or toxicity profiles. Well established indications for combination antimicrobial therapy include: (a) empirical treatment of life-threatening infections; (b) treatment of polymicrobial infections; (c) prevention of the emergence of bacterial resistance; and (d) for synergism. Disadvantages of combination therapy include: (a) increased expense; (b) increased risk of adverse effects; (c) antagonism; and (d) superinfection. Combination antimicrobial therapy should be considered for the treatment of serious Gram-negative infections caused by Enterobacter cloacae, Pseudomonas aeruginosa and Serratia marcescens, and certain Gram-positive infections caused by Enterococcus spp. and Staphylococcus spp. Selection of agents should be dependent upon local susceptibility patterns, clinical experience, site of infection, potential toxicities and cost.
只要有抗菌药物，就一直有人使用抗菌药物联合疗法。抗生素联合使用通常是为了利用不同的作用机制和/或毒性特征。已明确的联合抗菌疗法适应症包括：（a）对危及生命的感染进行经验性治疗；（b）治疗多种微生物感染；（c）预防细菌耐药性的出现；以及（d）产生协同作用。联合疗法的缺点包括：（a）费用增加；（b）不良反应风险增加；（c）拮抗作用；以及（d）二重感染。对于由阴沟肠杆菌、铜绿假单胞菌和粘质沙雷氏菌引起的严重革兰氏阴性感染，以及由肠球菌属和葡萄球菌属引起的某些革兰氏阳性感染，应考虑采用联合抗菌疗法。药物的选择应取决于当地的药敏模式、临床经验、感染部位、潜在毒性和成本。
