Peterson L R
Evanston Northwestern Healthcare, The Feinberg School of Medicine at Northwestern University, Evanstown, IL 60201, USA.
Clin Microbiol Infect. 2005 Oct;11 Suppl 5:4-16. doi: 10.1111/j.1469-0691.2005.01238.x.
The ongoing problem of emerging antimicrobial resistance has been likened to a balloon where settling one specific issue results in a 'bulge' of even worse problems. However, much has been learned about how to best use our critical antibacterial agents in ways to avoid or even repair some of the resistance damage that has been done. A compilation of current literature strongly suggests that to slow the development of resistance to antimicrobial agents it is optimal to use drugs with more than one mechanism of action or target, to prescribe those with demonstrated ability to minimise or reverse resistance problems, and to avoid underdosing of potent antibiotics. The most recent information also indicates that it is best to limit empirical use of beta-lactam plus fluoroquinolone combination therapy, since these two classes activate some common resistance responses, and using them together can facilitate multidrug resistance in important pathogens, particularly Pseudomonas aeruginosa and Acinetobacter species. This review discusses the role of each major antimicrobial class on resistance development and presents specific strategies for combating the growing problem of multidrug-resistant bacteria. We now have the knowledge to better manage our antimicrobial agent prescribing practices, but finding the will and resources to apply our understanding remains a formidable challenge.
不断出现的抗菌药物耐药性这一持续存在的问题,被比作一个气球,解决一个特定问题会导致更严重问题的“凸起”。然而,我们已经了解了很多如何以最佳方式使用关键抗菌药物,来避免甚至修复已经造成的一些耐药性损害。当前文献的汇编强烈表明,为了减缓对抗菌药物耐药性的发展,最好使用具有多种作用机制或靶点的药物,开出处方时选择那些已证明有能力将耐药性问题降至最低或逆转耐药性问题的药物,并避免强效抗生素剂量不足。最新信息还表明,最好限制β-内酰胺类药物与氟喹诺酮类药物联合治疗的经验性使用,因为这两类药物会引发一些常见的耐药反应,一起使用会促使重要病原体,特别是铜绿假单胞菌和不动杆菌属产生多重耐药性。本综述讨论了每类主要抗菌药物在耐药性发展中的作用,并提出了应对多重耐药菌这一日益严重问题的具体策略。我们现在有了更好地管理抗菌药物处方行为的知识,但找到意愿和资源来应用我们的理解仍然是一项艰巨的挑战。