Calvo Jorge, Martínez-Martínez Luis
Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla, Santander, España.
Enferm Infecc Microbiol Clin. 2009 Jan;27(1):44-52. doi: 10.1016/j.eimc.2008.11.001. Epub 2009 Jan 22.
A large number of families and groups of antimicrobial agents are of clinical interest. The mechanisms by which compounds with antibacterial activity inhibit growth or cause bacterial death are varied and depend on the affected targets. The bacterial cell wall-a unique structure in most bacteria that is absent in eukaryotic cells-can be affected in several ways: at different stages of synthesis (fosfomycin, cycloserine) or transport (bacitracin, mureidomycins) of its metabolic precursors, or by a direct action on its structural organization (beta-lactams, glycopeptides). The main drugs affecting the cytoplasmic membrane are polymyxins and daptomycin. Protein synthesis can be blocked by a large variety of compounds that affect any of the phases of this process, including activation (mupirocin), initiation (oxazolidinones, aminoglycosides), binding of the tRNA amino acid complex to ribosomes (tetracyclines, glycylcyclines) and elongation (amphenicols, lincosamides, macrolides, ketolides, streptogramins, fusidic acid). The metabolism of nucleic acids can be altered at the DNA-dependent RNA polymerase or in the process of DNA coiling (quinolones); some compounds affect DNA directly (nitroimidazoles, nitrofurans). Trimethoprim and sulfamides (often used in combination) are examples of antimicrobial agents that block bacterial metabolic pathways. Some compounds are unable to inhibit or kill bacteria in themselves, but can block bacterial mechanisms of resistance, enhancing the activity of other antimicrobials administered in combination. Among this group of agents, only certain beta-lactamase inhibitors are currently in clinical use.
大量的抗菌药物类别和组合具有临床意义。具有抗菌活性的化合物抑制细菌生长或导致细菌死亡的机制多种多样,且取决于受影响的靶点。细菌细胞壁——大多数细菌中特有的结构,而在真核细胞中不存在——可通过多种方式受到影响:在其代谢前体的合成(磷霉素、环丝氨酸)或转运(杆菌肽、多粘菌素)的不同阶段,或通过对其结构组织的直接作用(β-内酰胺类、糖肽类)。影响细胞质膜的主要药物是多粘菌素和达托霉素。蛋白质合成可被多种影响该过程任何阶段的化合物阻断,包括激活(莫匹罗星)、起始(恶唑烷酮类、氨基糖苷类)、tRNA氨基酸复合物与核糖体的结合(四环素类、甘氨酰环素类)以及延伸(氯霉素类、林可酰胺类、大环内酯类、酮内酯类、链阳菌素类、夫西地酸)。核酸代谢可在依赖DNA的RNA聚合酶水平或DNA盘绕过程中发生改变(喹诺酮类);一些化合物直接影响DNA(硝基咪唑类、硝基呋喃类)。甲氧苄啶和磺胺类药物(常联合使用)是阻断细菌代谢途径的抗菌药物实例。一些化合物本身无法抑制或杀死细菌,但可阻断细菌的耐药机制,增强联合使用的其他抗菌药物的活性。在这一类药物中,目前只有某些β-内酰胺酶抑制剂在临床使用。