Brown Jack, Freeman Burgess B
Department of Infectious Disease and Pharmacy, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756-0001, USA.
Ann Pharmacother. 2004 Apr;38(4):677-85. doi: 10.1345/aph.1D323. Epub 2004 Feb 27.
To review the resistance mechanisms of Enterococcus and Staphylococcus spp. and summarize quinupristin/dalfopristin's (QD's) effects on these resistant organisms when combined with other antibiotics via review of the literature and unpublished data.
Data were identified by a PubMed search (1996-May 2003) using the search terms quinupristin/dalfopristin, synergy, in vitro, in vivo, vancomycin-resistant Enterococcus faecium (VREF), methicillin-resistant Staphylococcus aureus (MRSA), and individual antibiotic names. Bibliographies of the resultant PubMed searches were reviewed and included if applicable.
All studies reviewed were analyzed; specific drug data were included only if clinically pertinent. In vitro data from studies with adequate design were discussed, whereas all case reports and clinical trials were utilized.
In the treatment of VREF, available information seems conflicting, although some clear differences have become apparent. QD-ampicillin and QD-doxycycline combinations have demonstrated beneficial activity, usually displaying synergistic or additive effects even in macrolide-, lincosamine-, and streptogramin-resistant (MLSB) isolates. Vancomycin and chloramphenicol have shown some efficacy, but antagonistic or null results also have been observed. Regarding MRSA, results from many studies of QD combinations have been ambiguous. More common combinations displayed synergy or additive effects against MRSA, but only QD-rifampin showed consistent beneficial activity against MRSA and MLSB isolates. Most other combinations displayed antagonism when tested in vitro.
Data supporting the use of various QD-antibiotic combinations against VREF and MRSA are increasing, but further in vitro and in vivo data are needed to confirm the findings.
通过回顾文献及未发表的数据，综述肠球菌属和葡萄球菌属的耐药机制，并总结奎奴普丁/达福普汀（QD）与其他抗生素联合使用时对这些耐药菌的作用。
通过PubMed搜索（1996年至2003年5月）确定数据，搜索词为奎奴普丁/达福普汀、协同作用、体外、体内、耐万古霉素屎肠球菌（VREF）、耐甲氧西林金黄色葡萄球菌（MRSA）以及各抗生素名称。对PubMed搜索结果的参考文献进行了审查，如有适用则纳入。
对所有综述的研究进行分析；仅纳入临床相关的特定药物数据。讨论了设计充分的研究的体外数据，同时利用了所有病例报告和临床试验。
在VREF的治疗中，现有信息似乎相互矛盾，尽管一些明显差异已显现出来。QD-氨苄西林和QD-多西环素组合已显示出有益活性，即使在对大环内酯类、林可酰胺类和链阳菌素耐药（MLSB）的分离株中通常也表现出协同或相加作用。万古霉素和氯霉素已显示出一定疗效，但也观察到了拮抗或无效结果。关于MRSA，许多QD组合研究的结果不明确。更常见的组合对MRSA显示出协同或相加作用，但只有QD-利福平对MRSA和MLSB分离株显示出一致的有益活性。大多数其他组合在体外测试时表现出拮抗作用。
支持使用各种QD-抗生素组合治疗VREF和MRSA的数据在增加，但需要进一步的体外和体内数据来证实这些发现。
