Molina José, Cordero Elisa, Palomino Julián, Pachón Jerónimo
Servicio de Enfermedades Infecciosas, Hospitales Universitarios Virgen del Rocío, Sevilla, España.
Enferm Infecc Microbiol Clin. 2009 Mar;27(3):178-88. doi: 10.1016/j.eimc.2009.02.001.
The emergence of multidrug-resistant strains of gram-negative bacilli during the last decade has generated renewed interest in older antimicrobials that had been relegated to a second line because of a poorer safety profile, but that are still active against these microorganisms. Once-daily administration of aminoglycosides has limited the toxicity of these agents and enabled their reintroduction into clinical practice. Recent studies have shown no additional benefits of concomitant administration of aminoglycosides with current ss-lactams, and the available evidence does not support the use of once-daily administration for all indications. The new formulations and dosages of polymyxins have also reduced the toxicity rates attributed to these agents in the past. Although more extensive studies are required to properly define their pharmacokinetics and effectiveness, the available data have shown favorable outcomes for patients with infection due to multiresistant gram-negative bacilli treated with colistin, either alone or combined with other antimicrobial agents.
在过去十年中，革兰氏阴性杆菌多重耐药菌株的出现，使人们重新关注起那些因安全性较差而被降为二线用药，但仍对这些微生物有效的较老抗菌药物。氨基糖苷类药物的每日一次给药方式限制了这些药物的毒性，并使其能够重新应用于临床实践。最近的研究表明，氨基糖苷类药物与目前的β-内酰胺类药物联合使用并无额外益处，现有证据也不支持将每日一次给药用于所有适应症。多粘菌素的新剂型和剂量也降低了过去归因于这些药物的毒性发生率。尽管需要更广泛的研究来准确界定其药代动力学和有效性，但现有数据表明，对于由多耐药革兰氏阴性杆菌引起感染的患者，单独使用黏菌素或与其他抗菌药物联合使用，均取得了良好的治疗效果。
