Janknegt R
Department of Clinical Pharmacy, Maasland Hospital, Sittard, The Netherlands.
Pharm Weekbl Sci. 1990 Jun 22;12(3):81-90. doi: 10.1007/BF01967600.
The microbiological, pharmacokinetic, toxicological and clinical aspects of aminoglycosides are reviewed. Aminoglycosides still have an important place in serious infections in neutropenic patients, endocarditis and Pseudomonas aeruginosa infections, all in combination with beta-lactams. Monotherapy (with streptomycin) is indicated in less common diseases like tularemia and bubonic plague. Several experimental studies support a once-daily dosing regimen for aminoglycosides (comparable or better efficacy with less ototoxicity and nephrotoxicity). Only a very limited number of prospective comparative studies have been performed, and much more data on efficacy, development of resistance and toxicity is needed before once-daily administration can be recommended. The choice of an aminoglycoside should be based primarily on the local sensitivity patterns and cost. Differences in ototoxicity and nephrotoxicity are usually minor. If the acquisition costs of amikacin decline, it is to be expected that amikacin will be the aminoglycoside of choice.
本文综述了氨基糖苷类药物的微生物学、药代动力学、毒理学及临床方面的内容。氨基糖苷类药物在中性粒细胞减少患者的严重感染、心内膜炎及铜绿假单胞菌感染的治疗中，与β-内酰胺类药物联合使用时仍占有重要地位。在兔热病和腺鼠疫等较罕见疾病中，可采用单一疗法（使用链霉素）。多项实验研究支持氨基糖苷类药物每日一次的给药方案（疗效相当或更佳，耳毒性和肾毒性更低）。目前仅进行了非常有限的前瞻性对照研究，在推荐每日一次给药方案之前，还需要更多关于疗效、耐药性发展及毒性的数据。氨基糖苷类药物的选择应主要基于当地的敏感性模式和成本。耳毒性和肾毒性的差异通常较小。如果阿米卡星的购置成本下降，预计阿米卡星将成为首选的氨基糖苷类药物。
