Dhariwal A K, Tullu M S
Department of Pediatrics, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India.
J Postgrad Med. 2013 Jul-Sep;59(3):208-15. doi: 10.4103/0022-3859.118040.
The treatment of the emerging multidrug resistant (MDR) gram-negative organisms is a challenge. The development of newer antibiotics has recently slowed down. This has led to the re-emergence of the 'old forgotten' antibiotic "Colistin", whose use had almost stopped (after 1970's) due to the high incidence of nephrotoxicity and neurotoxicity. Colistin (polymyxin E) is a polypeptide antibiotic belonging to polymyxin group of antibiotics with activity mainly against the gram-negative organisms. Use of colistin has been increasing in the recent past and newer studies have shown lesser toxicity and good efficacy. Colistin acts on the bacterial cell membrane resulting in increased cell permeability and cell lysis. Colistin can be administered orally, topically, by inhalational route, intramuscularly, intrathecally, and also intravenously. Parenteral Colistin (in the form of colistimethate sodium) has been used to treat ventilator-associated pneumonia (VAP) and bacteremia caused by MDR bacteria such as Pseudomonas aeruginosa, Klebsiella pneumoniae, and Acinetobacter baumannii. Inhaled Colistin is used for treating pneumonia/VAP due to MDR gram-negative organisms and also used prophylactically in patients with cystic fibrosis. This manuscript is a brief review of Colistin and its clinical applications in the pediatric population.
新兴的多重耐药革兰氏阴性菌的治疗是一项挑战。近年来，新型抗生素的研发速度有所放缓。这导致了“被遗忘的旧”抗生素“多粘菌素”的重新出现，由于其肾毒性和神经毒性发生率高，其使用在20世纪70年代后几乎停止。多粘菌素（多粘菌素E）是一种属于多粘菌素类抗生素的多肽抗生素，主要对革兰氏阴性菌有活性。近年来，多粘菌素的使用一直在增加，新的研究表明其毒性较小且疗效良好。多粘菌素作用于细菌细胞膜，导致细胞通透性增加和细胞裂解。多粘菌素可以口服、局部应用、吸入、肌肉注射、鞘内注射以及静脉注射。肠外多粘菌素（以多粘菌素甲磺酸钠的形式）已被用于治疗由多重耐药细菌如铜绿假单胞菌、肺炎克雷伯菌和鲍曼不动杆菌引起的呼吸机相关性肺炎（VAP）和菌血症。吸入性多粘菌素用于治疗由多重耐药革兰氏阴性菌引起的肺炎/VAP，也用于囊性纤维化患者的预防。本文是对多粘菌素及其在儿科人群中的临床应用的简要综述。
