A PRACTICAL LOOK AT THE CLINICAL USEFULNESS OF THE BETA-LACTAM BETA-LACTAMASE INHIBITOR COMBINATIONS/

OBJECTIVE: To aid clinicians in developing an approach to the use of i ntravenous beta-lactam/beta-lactamase inhibitors on a patient-specific basis. To achieve this, the pharmacology, in vitro activity, and clin ical use of the intravenous beta-lactam/beta-lactamase inhibitor combi nations in the treatment of selected infections seen in hospitalized p atients are discussed. DATA IDENTIFICATION: An English-language litera ture search using MEDLINE (1987-1995); Index Medicus (1987-1995); prog ram and abstracts of the 32nd (1992), 33rd (1993), 34th (1994), and 35 th (1995) Interscience Conference on Antimicrobial Agents and Chemothe rapy; bibliographic reviews of review articles; and package inserts. S TUDY SELECTION: In vitro and in vivo studies on the pharmacokinetics, microbiology, pharmacology, and clinical effectiveness of ampicillin/s ulbactam, ticarcillin/clavulanate, and piperacillin/tazobactam were ev aluated. DATA SYNTHESIS: Many properties of the beta-lactam/beta-lacta mase inhibitor combinations are similar. Differences in dosing, suscep tibilities, and clinical applications are important considerations for clinicians. Potential roles for these agents in the clinical setting include pneumonia, intraabdominal infections, and soft tissue infectio ns. A short discussion on susceptibility data interpretation is also p resented. CONCLUSIONS: There are important differences among the avail able beta-lactam/beta-lactamase inhibitor combinations, such as spectr a of activity, which need to be considered in choosing an agent for a patient-specific case. These products can be useful alternatives to co nventional two- to three-drug regimens in mixed infections such as foo t infections in patients with diabetes and hospital-acquired intraabdo minal infections.