Janknegt R
Maasland Ziekenhuis, Dept. of Clinical Pharmacy and Toxicology, Sittard, The Netherlands.
Pharm World Sci. 1997 Jun;19(3):133-41. doi: 10.1023/a:1008609718457.
The choice of antibiotics for the treatment of staphylococcal infections depends to a high degree on the susceptibility patterns in the hospital in question. These may be highly variable and considerable differences between countries and hospitals exist. The insight into the pharmacodynamic aspects of antimicrobial agents has increased considerably in the last 5 years, resulting in new treatments, such as once daily administration of aminoglycosides and continuous infusion of betalactam antibiotics. The antibiotic policy in Dutch hospitals for the treatment of staphylococcal infections is discussed. In most Western countries with a relatively low incidence of MRSA, penicillin-derivatives, such as flucloxacillin (or cloxacillin, methicillin and nafcillin) will be the drug of choice, because of their good in-vitro activity, low toxicity, good clinical efficacy and relatively low cost. If the incidence of MRSA increases, drugs such as the glycopeptides will be of more importance. This will of course have a clear economic impact, as both vancomycin and teicoplanin are considerably more expensive than agents such as flucloxacillin and oral treatment is not possible. Pharmacoeconomic aspects also play a role. As a rule, intravenous antimicrobial agents are considerably more expensive than the oral formulations. Before oral administration can be recommended, a reliable oral absorption, also in seriously ill patients, must have been demonstrated. Other aspects that influence the cost of therapy are hospital stay and the possibility of outpatient treatment.
治疗葡萄球菌感染时抗生素的选择在很大程度上取决于相关医院的药敏模式。这些模式可能差异很大，不同国家和医院之间存在显著差异。在过去5年里，对抗菌药物药效学方面的认识有了显著提高，从而产生了新的治疗方法，如氨基糖苷类药物每日一次给药和β-内酰胺类抗生素持续输注。本文讨论了荷兰医院治疗葡萄球菌感染的抗生素政策。在大多数耐甲氧西林金黄色葡萄球菌（MRSA）发病率相对较低的西方国家，青霉素衍生物，如氟氯西林（或氯唑西林、甲氧西林和萘夫西林）将是首选药物，因为它们具有良好的体外活性、低毒性、良好的临床疗效和相对较低的成本。如果MRSA的发病率增加，糖肽类等药物将变得更为重要。这当然会产生明显的经济影响，因为万古霉素和替考拉宁都比氟氯西林等药物贵得多，而且无法进行口服治疗。药物经济学方面也发挥着作用。通常，静脉用抗菌药物比口服制剂贵得多。在推荐口服给药之前，必须证明即使是重症患者也能可靠地口服吸收。影响治疗费用的其他因素包括住院时间和门诊治疗的可能性。
