Edson R S, Terrell C L
Division of Infectious Diseases and Internal Medicine, Mayo Clinic Rochester, Minnesota 55905, USA.
Mayo Clin Proc. 1999 May;74(5):519-28. doi: 10.4065/74.5.519.
Despite the introduction of newer, less toxic antimicrobial agents, the aminoglycosides continue to serve a useful role in the treatment of serious enterococcal, mycobacterial, and gram-negative bacillary infections. Gentamicin, because of its low cost, remains the aminoglycoside of choice in hospitals with low levels of resistance among Enterobacteriaceae and Pseudomonas aeruginosa. Typically, it is administered in combination with beta-lactam antibiotics, but it may also be used as monotherapy for urinary tract infections or tularemia. Amikacin is useful against gentamicin-resistant gram-negative bacilli and also in the treatment of infections caused by susceptible Nocardia and nontuberculous mycobacteria. Streptomycin serves an important role in the treatment of multidrug-resistant tuberculosis and may be useful in the treatment of some gentamicin-resistant enterococcal infections. Despite an alarming increase in aminoglycoside-resistant enterococci, most institutions have noted little change in patterns of resistance among gram-negative bacilli. Although the development of newer, less toxic aminoglycosides is unlikely in the near future, single daily dosing regimens have been proposed as a convenient, cost-effective strategy. In selected patients, this novel approach seems to be as safe and effective as traditional, multidose regimens.
尽管引入了更新的、毒性较小的抗菌药物，但氨基糖苷类药物在治疗严重的肠球菌、分枝杆菌和革兰氏阴性杆菌感染方面仍发挥着重要作用。庆大霉素由于成本低，在肠杆菌科细菌和铜绿假单胞菌耐药水平较低的医院中仍是首选的氨基糖苷类药物。通常，它与β-内酰胺类抗生素联合使用，但也可作为尿路感染或兔热病的单一疗法。阿米卡星对耐庆大霉素的革兰氏阴性杆菌有效，也可用于治疗由敏感诺卡菌和非结核分枝杆菌引起的感染。链霉素在耐多药结核病的治疗中起着重要作用，也可能对一些耐庆大霉素的肠球菌感染有效。尽管耐氨基糖苷类肠球菌的数量惊人地增加，但大多数机构注意到革兰氏阴性杆菌的耐药模式变化不大。尽管近期不太可能开发出新的、毒性更小的氨基糖苷类药物，但已提出每日单次给药方案作为一种方便、经济有效的策略。在选定的患者中，这种新方法似乎与传统的多剂量方案一样安全有效。
