Poole Keith
Department of Microbiology & Immunology, Queen's University, Kingston, Ontario, Canada, K7L 3N6.
Curr Opin Investig Drugs. 2003 Feb;4(2):128-39.
The incidence of Gram-negative pathogens resistant to multiple antibiotics and multiple classes of antibiotics is increasing and the resultant deficit in effective therapeutic agents emphasizes the urgent need for novel agents and novel therapeutic approaches to the treatment of Gram-negative infectious disease. While developing versions of existing agents able to overcome resistance, or targeting resistance itself are strategies being considered to deal with multidrug resistance, genomic approaches will ultimately provide a multitude of novel targets for the development of new classes of agents likely to be unaffected by existing resistance mechanisms. The use of 'natural' antibacterials such as cationic antimicrobial peptides and bacteriophage as therapeutic agents is also being pursued. With an increased understanding of the infection process, immunomodulation and vaccinology are increasingly useful approaches to infectious disease management in the face of increasing antimicrobial resistance. Finally, there is a need to rigorously implement appropriate prescribing and infection control practices, to minimize the risk of resistance development and spread. Clearly, the antibiotic era has not heralded the defeat of infectious disease and prudent use of novel therapies is imperative if we are to avoid entering the post-antimicrobial era.
对多种抗生素及多类抗生素耐药的革兰氏阴性病原体的发生率正在上升，有效治疗药物的短缺凸显了迫切需要新型药物和新型治疗方法来治疗革兰氏阴性传染病。虽然开发能够克服耐药性的现有药物版本或针对耐药性本身是应对多重耐药性的策略，但基因组方法最终将为开发可能不受现有耐药机制影响的新型药物提供大量新靶点。使用“天然”抗菌剂，如阳离子抗菌肽和噬菌体作为治疗药物也在探索之中。随着对感染过程的深入了解，面对日益增加的抗菌药物耐药性，免疫调节和疫苗学在传染病管理中越来越有用。最后，需要严格实施适当的处方和感染控制措施，以尽量减少耐药性产生和传播的风险。显然，抗生素时代并未宣告战胜传染病，如果我们要避免进入后抗生素时代，审慎使用新型疗法势在必行。
