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面对多重耐药菌,抗感染治疗中有哪些可供我们选择的方法?

[Which alternatives are at our disposal in the anti-infectious therapeutics face to multi-drug resistant bacteria?].

作者信息

Bourlioux P

机构信息

Faculté de pharmacie, Académie nationale de pharmacie, 11, avenue de la République, 94400 Vitry-sur-Seine, France.

出版信息

Ann Pharm Fr. 2013 May;71(3):150-8. doi: 10.1016/j.pharma.2013.02.005. Epub 2013 Apr 6.

Abstract

The development of multi-drug resistance to antibiotics during the last years and the few number of new active molecules launched on the market have limited the treatment of some infectious diseases. Which alternatives are at our disposal in the anti-infectious therapeutics face to multi-drug resistant bacteria? Considering the bibliographic data, we can note different facts: (1) some alternatives already exist, but correspond more to targeted useful and usable therapeutics as phage therapy, honey therapy, or maggot therapy; (2) some "old" antibiotics can find new bacterial targets and reinforce the anti-infectious therapy towards some multi-drug resistant bacteria; (3) new formulations can allow targeted drug delivery via nanoparticles and the association of molecules can reinforce the antibiotic antimicrobial effect; (4) new treatment could be potentially usable as: antimicrobial peptides, probiotics, herbal medicines, statins, phosphonosulfonates, fecal transplants...; (5) at least, we must not forget that "it's better to prevent than cure". So, besides the principles of hygiene that must be respected, it is necessary to promote (if possible) the development of new vaccines against bacteria responsible for nosocomial infections. Facing with this potential, we can say that new orientations are open with very different levels of success and that it is urgent to find new targets ignored or forgotten until now.

摘要

在过去几年中,抗生素多药耐药性的发展以及市场上推出的新活性分子数量有限,限制了一些传染病的治疗。面对多重耐药细菌,抗感染治疗中有哪些可供我们选择的替代方法呢?考虑到文献数据,我们可以注意到不同的情况:(1)一些替代方法已经存在,但更多地对应于有针对性的有用且可用的治疗方法,如噬菌体疗法、蜂蜜疗法或蛆虫疗法;(2)一些“老”抗生素可以找到新的细菌靶点,并加强对一些多重耐药细菌的抗感染治疗;(3)新的制剂可以通过纳米颗粒实现靶向给药,分子联合使用可以增强抗生素的抗菌效果;(4)新的治疗方法可能有:抗菌肽、益生菌、草药、他汀类药物、膦酰基磺酸盐、粪便移植……;(5)至少,我们不能忘记“预防胜于治疗”。因此,除了必须遵守的卫生原则外,有必要(如果可能的话)推动针对医院感染病原菌的新疫苗的研发。面对这种潜力,我们可以说新的方向已经开启,成功程度各不相同,而且迫切需要找到迄今被忽视或遗忘的新靶点。

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