Scheetz Marc H, Hurt Kristin M, Noskin Gary A, Oliphant Catherine M
Department of Pharmacy, Northwestern Memorial Hospital, Chicago, IL 60611, USA.
Am J Health Syst Pharm. 2006 Jul 15;63(14):1346-60. doi: 10.2146/ajhp050403.
Guided antibiotic adjustment for the treatment of multidrug-resistant, gram-negative pathogens is explored.
Multidrug-resistant pathogens are being isolated with increasing frequency, while the production of novel agents to circumvent resistance has slowed to a near halt. Hence, antimicrobial adjustment based on drug pharmacokinetic and pharmacodynamic properties has moved to the forefront of treatment. Pharmacodynamic principles for major classes of antimicrobials are reviewed, and the use of susceptibility reports to optimize pharmacodynamics to treat gram-negative infections is described. The need for the application of antimicrobial pharmacodynamics continues to grow as resistance to the agents becomes more common. Susceptibility reports, including antibiograms, and their limitations are briefly discussed. The resistance profiles of the beta-lactams (including carbapenems), aminoglycosides, fluoroquinolones, tetracyclines and glycylcyclines, and the polymyxins are reviewed, and the pharmacodynamic optimization of these profiles is explored.
Various mechanisms account for resistance of bacteria to antibiotics. The appropriate use of pharmacokinetics and pharmacodynamics can guide antibiotic therapy and enhance the likelihood of success.
探讨用于治疗多重耐药革兰氏阴性病原体的抗生素调整策略。
多重耐药病原体的分离频率日益增加，而开发新的抗耐药药物的速度已近乎停滞。因此，基于药物药代动力学和药效学特性的抗菌药物调整已成为治疗的前沿。本文回顾了主要抗菌药物类别的药效学原理，并描述了如何利用药敏报告优化药效学以治疗革兰氏阴性菌感染。随着对这些药物的耐药性变得更加普遍，应用抗菌药物药效学的需求持续增长。本文简要讨论了药敏报告（包括抗菌谱）及其局限性。回顾了β-内酰胺类（包括碳青霉烯类）、氨基糖苷类、氟喹诺酮类、四环素类和甘氨酰环素类以及多粘菌素类的耐药情况，并探讨了这些耐药情况的药效学优化。
细菌对抗生素产生耐药性有多种机制。合理运用药代动力学和药效学可指导抗生素治疗并提高成功的可能性。
