Zusammenfassung
Eine Kombination aus β-Laktam-Antibiotikum und β-Laktamase-Inhibitor (Clavulansäure, Tazobactam, Sulbactam) erweitert das Wirkungsspektrum des Antibiotikums (z. B. Anaerobier) und führt dazu, dass Erreger mit β-Laktamase-Bildung zumindest teilweise wieder sensibel gegenüber dem Antibiotikum als eigentlich wirksamer Substanz werden. In Deutschland sind die β-Laktamase-Inhibitoren Tazobactam und Sulbactam zur Therapie schwerer Infektionen in Kombination mit Piperacillin zugelassen. In dieser Übersichtsarbeit werden pharmakokinetische, pharmakodynamische und klinische Daten von Piperacillin/Tazobactam und Piperacillin/Sulbactam verglichen. Insgesamt ist die klinische Wirksamkeit von Piperacillin/Tazobactam bei nosokomial erworbener Pneumonie, schweren intraabdominalen Infektionen oder Fieber bei neutropenischen Patienten sehr gut dokumentiert und der Wirksamkeit von Carbapenem oder Cefalosporinen der 3. Generation (z. B. Ceftazidim) gleichwertig oder überlegen. Da kontrollierte klinische Studien zu Piperacillin/Sulbactam weitestgehend fehlen, ist eine Einschätzung seiner Effektivität im Vergleich zu anderen Substanzen nicht möglich.
Summary
Combination of β-lactam antibiotics and β-lactamase inhibitors (clavulanic acid, tazobactam, sulbactam) extends the spectrum of the β-lactam (e. g. anaerobes) and makes pathogens with β-lactamase production at least partially sensitive to the antibiotic. In Germany, tazobactam and sulbactam are both licensed for therapy of severe infections in combination with piperacillin. This review compares pharmacokinetic, pharmacodynamic and clinical data of piperacillin/tazobactam and piperacillin/sulbactam. The efficacy of piperacillin/tazobactam in the treatment of patients with nosocomial pneumonia, severe intra-abdominal infections or fever of unknown origin in neutropenic patients is equivalent or better than comparators like carbapenems or 3rd generation cefalosporins (e. g. ceftazidime). Because there is a paucity of controlled clinical data, an estimation of the clinical efficacy of piperacillin/sulbactam in comparison to other substances is not possible.
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Heizmann, W.R., Derendorf, H. Kriterien zur Abgrenzung der Kombinationen Piperacillin/Tazobactam und Piperacillin/Sulbactam. Z Herz- Thorax- Gefäßchir 19, 89–99 (2005). https://doi.org/10.1007/s00398-005-0487-z
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DOI: https://doi.org/10.1007/s00398-005-0487-z