Nation Roger L, Li Jian
Facility for Anti-Infective Drug Development and Innovation, Victorian College of Pharmacy, Monash University, 381 Royal Parade, Parkville, Victoria, Australia.
Semin Respir Crit Care Med. 2007 Dec;28(6):604-14. doi: 10.1055/s-2007-996407.
Polymyxin B and colistin are being used increasingly for the treatment of infections caused by gram-negative bacteria that are resistant to all other currently available antibiotics. Although the polymyxins have been available in the clinic for around 50 years, they have never been subjected to the drug development procedures required of modern pharmaceuticals. As a result, the available knowledge on the pharmacokinetics (PK), pharmacodynamics (PD), and toxicodynamics (TD) of the polymyxins is limited. Although significant advances have been made in the last 5 years or so, there are still large gaps in our understanding of the PK, PD, and TD, and of the PK/PD and PK/TD relationships. This information is required to generate recommendations on dosage regimens for various categories of critically ill patients. This paper reviews the growing understanding of the pharmacology of the polymyxins and factors that may impact on the optimization of the dose of these antibiotics in critically ill patients.
多黏菌素B和黏菌素越来越多地用于治疗由对所有其他现有抗生素耐药的革兰氏阴性菌引起的感染。尽管多黏菌素已在临床上使用了约50年，但它们从未经历过现代药物所需的药物开发程序。因此，关于多黏菌素的药代动力学（PK）、药效学（PD）和毒效学（TD）的现有知识有限。尽管在过去5年左右取得了重大进展，但我们对PK、PD和TD以及PK/PD和PK/TD关系的理解仍存在很大差距。这些信息对于为各类重症患者制定给药方案的建议是必需的。本文综述了对多黏菌素药理学的日益深入的理解以及可能影响这些抗生素在重症患者中剂量优化的因素。
