Child Health and Nottingham Respiratory Biomedical Research Unit, Queens Medical Centre, University of Nottingham, Nottingham, UK.
Curr Opin Pulm Med. 2010 Nov;16(6):604-10. doi: 10.1097/MCP.0b013e32833eebfd.
This review summarizes the recent literature regarding the uses for and toxicity of aminoglycosides in cystic fibrosis (CF).
Aminoglycosides are indicated in the management of acute exacerbations of CF, to control chronic infection, and to eradicate Pseudomonas aeruginosa after recent acquisition. Intravenous gentamicin is associated with increased risk of acute kidney injury, whereas intravenous tobramycin is less so. Studies regarding chronic kidney disease related to cumulative aminoglycoside exposure are currently conflicting, but a prevalence of up to 42% has been reported. A single daily dose of intravenous tobramycin is as effective as a thrice-daily regimen and is less nephrotoxic. A large paediatric series has recently reported a prevalence of hearing impairment of 4.5%, and a small adult cohort has found a 30% rate of vestibulotoxicity. Neither appears to be related to cumulative exposure.
In recent years, the well known toxicities of aminoglycosides have been investigated in CF populations. It appears that intravenous tobramycin is well tolerated in the kidneys compared with gentamicin, and that cumulative exposure may result in chronic kidney disease. Hearing loss and vestibulotoxicity are also prevalent. These important epidemiological studies lay the groundwork to design interventional studies to reduce toxicity.
本文总结了关于氨基糖苷类药物在囊性纤维化（CF）中的应用和毒性的最新文献。
氨基糖苷类药物在 CF 急性加重期的治疗、慢性感染的控制以及近期获得后铜绿假单胞菌的清除中均有应用。静脉注射庆大霉素与急性肾损伤风险增加相关，而静脉注射妥布霉素则风险较低。关于与累积氨基糖苷类暴露相关的慢性肾脏病的研究目前存在争议，但已有高达 42%的报道。每日单次静脉注射妥布霉素与每日三次方案同样有效，且肾毒性较低。最近的一项大型儿科系列研究报告了听力损伤的患病率为 4.5%，而一项小型成人队列研究发现前庭毒性的发生率为 30%。两者似乎都与累积暴露无关。
近年来，已在 CF 人群中研究了氨基糖苷类药物的已知毒性。与庆大霉素相比，静脉注射妥布霉素在肾脏中耐受性良好，且累积暴露可能导致慢性肾脏病。听力损失和前庭毒性也很常见。这些重要的流行病学研究为设计减少毒性的干预性研究奠定了基础。
