University Hospital Virgen del Rocío, Institute of Biomedicine of Sevilla, Infectious Diseases Service, Av. Manuel Siurot s/n, 41013, Sevilla, Spain.
Expert Opin Pharmacother. 2009 Dec;10(17):2811-28. doi: 10.1517/14656560903334185.
Infections by multidrug resistant Gram-negative bacilli (MDR-GNB) have become a major threat for patients hospitalized in intensive care units, representing a prevalent cause of morbimortality in the critically ill, since these microorganisms have developed resistance to most available antimicrobial agents. In this respect, very few therapeutic innovations have been developed in recent years, and it is not foreseen that any new drugs will be commercialized in the near future. Tigecycline represents an effective alternative in this setting, but lacks activity against Pseudomonas aeruginosa, and its use has not been validated for all organ-specific infections. Frequently, only old antibiotics like colistin remain a valid option. New pharmaceutical formulations and dosage regimens of polymyxins have considerably reduced the toxicity previously attributed to these antimicrobials, and have made it possible to reintroduce them into clinical practice. Nonetheless, the effectiveness of polymyxins is still suboptimal, and the expansion of heteroresistance and pan-drug-resistant strains of gram-negative bacilli is of concern. Improvements in dosing, alternative methods of administration and different synergic antimicrobial combinations have been proposed in recent literature, among other measures, to enhance the effectiveness of polymyxins. The latest data regarding polymyxins and their clinical use are discussed in this review.
多重耐药革兰氏阴性菌（MDR-GNB）感染已成为重症监护病房住院患者的主要威胁，是危重病患者发病率和死亡率升高的主要原因，因为这些微生物对大多数现有抗菌药物产生了耐药性。在这方面，近年来几乎没有开发出任何治疗创新，而且预计在不久的将来不会有任何新药物上市。替加环素是这方面的有效替代药物，但对铜绿假单胞菌没有活性，其用途尚未针对所有特定器官的感染得到验证。通常，只有像黏菌素这样的旧抗生素仍然是一个有效的选择。多黏菌素类药物的新制剂和新剂量方案大大降低了这些抗菌药物以前的毒性，并使其能够重新引入临床实践。尽管如此，多黏菌素类药物的疗效仍不尽如人意，而且革兰氏阴性杆菌的异质耐药和泛耐药菌株的扩张令人担忧。最近的文献提出了改善剂量、替代给药方法和不同协同抗菌药物组合等措施，以提高多黏菌素类药物的疗效。本文讨论了关于多黏菌素类药物及其临床应用的最新数据。
