Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI 53705, USA.
Crit Care Clin. 2011 Jan;27(1):107-21. doi: 10.1016/j.ccc.2010.11.006.
The appearance of new third- and fourth-generation cephalosporins, carbapenems, and fluoroquinolones have decreased the use of aminoglycosides as monotherapy for most gram-negative infections. Historically, aminoglycosides were used in combination with other antibiotics to enhance bacterial killing and improve overall efficacy. However, most studies have failed to demonstrate improved outcomes in patients treated with antibiotic combinations over those receiving monotherapy. Only recently has early combination therapy been associated with reduced mortality in septic shock. This article reviews the pharmacokinetics, pharmacodynamics, and toxicodynamics of aminoglycosides, describing dosing strategies and other effects to improve outcomes in critically ill patients with serious infections.
新的第三代和第四代头孢菌素、碳青霉烯类和氟喹诺酮类药物的出现减少了氨基糖苷类药物作为大多数革兰氏阴性感染的单一疗法的使用。在历史上，氨基糖苷类药物与其他抗生素联合使用以增强杀菌作用并提高整体疗效。然而，大多数研究未能证明联合治疗的患者比单一治疗的患者的治疗结果有所改善。直到最近，早期联合治疗才与降低感染性休克患者的死亡率相关。本文综述了氨基糖苷类药物的药代动力学、药效学和毒代动力学，描述了剂量策略和其他作用，以改善严重感染的危重病患者的治疗效果。
