Burns, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia.
Int J Antimicrob Agents. 2010 Dec;36(6):491-500. doi: 10.1016/j.ijantimicag.2010.08.013. Epub 2010 Oct 16.
Pneumonia is a form of lung infection that may be caused by various micro-organisms. The predominant site of infection in pneumonia is debatable. Advances in the fields of diagnostic and therapeutic medicine have had a less than optimal effect on the outcome of pneumonia and one of the many causes is likely to be inadequate antimicrobial concentrations at the site of infection in lung tissue. Traditional antimicrobial therapy guidelines are based on indirect modelling from blood antimicrobial levels. However, studies both in humans and animals have shown the fallacy of this concept in various tissues. Many different methods have been employed to study lung tissue antimicrobial levels with limited success, and each has limitations that diminish their utility. An emerging technique being used to study the pharmacokinetics of antimicrobial agents in lung tissue is microdialysis. Development of microdialysis catheters, along with improvement in analytical techniques, has improved the accuracy of the data. Unfortunately, very few studies have reported the use of microdialysis in lung tissue, and even fewer antimicrobial classes have been studied. These studies generally suggest that this technique is a safe and effective way of assessing the pharmacokinetics of antimicrobial agents in lung tissue. Further descriptive studies need to be conducted to study the pharmacokinetics and pharmacodynamics of different antimicrobial classes in lung tissue. Data emanating from these studies could inform decisions for appropriate dosing schedules of antimicrobial agents in pneumonia.
肺炎是一种肺部感染形式，可能由各种微生物引起。感染的主要部位仍存在争议。诊断和治疗医学领域的进步对肺炎的结果并没有产生理想的影响，其中一个原因可能是肺部感染组织中的抗菌药物浓度不足。传统的抗菌治疗指南是基于血液中抗菌药物水平的间接建模。然而，人类和动物的研究表明，这一概念在各种组织中存在谬误。许多不同的方法已经被用于研究肺部组织中的抗菌药物浓度，但都收效甚微，而且每种方法都存在局限性，降低了它们的实用性。一种新兴的技术——微透析，正在被用于研究肺部组织中抗菌药物的药代动力学。微透析导管的发展以及分析技术的改进提高了数据的准确性。不幸的是，很少有研究报告使用微透析来研究肺部组织，而且研究的抗菌药物类别更少。这些研究表明，该技术是评估肺部组织中抗菌药物药代动力学的一种安全有效的方法。需要进一步进行描述性研究，以研究不同抗菌药物类别在肺部组织中的药代动力学和药效动力学。这些研究产生的数据可以为肺炎中抗菌药物的适当给药方案提供信息。
