Zavascki Alexandre P
Department of Internal Medicine, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Expert Rev Anti Infect Ther. 2014 May;12(5):531-3. doi: 10.1586/14787210.2014.902307. Epub 2014 Mar 25.
The initial use of polymyxins, polymyxin B and colistin (administered as a pro-drug colistin methanesulfonate sodium [CMS]), mostly relied on old pharmacokinetic (PK) studies that lacked appropriate methodology. In recent years, many PK studies in both animals and humans have provided more consistent evidence supporting better use of these invaluable antibiotics. However, translating preclinical data to clinical practice is not always an easy task and some may experience difficulties on how recent knowledge on polymyxins can be applied into the patients' care. Although many questions are still unresolved, there are consistent data able to improve clinical practice when prescribing initial and maintenance doses of both polymyxin B and CMS. Considering the importance of optimal use of polymyxins, this editorial discusses recent PK findings and how to take advantage of them at the bedside to improve the treatment of patient with extensively-drug-resistant Gram-negative bacterial infections.
多粘菌素、多粘菌素B和黏菌素（以黏菌素甲磺酸钠[CMS]这种前体药物形式给药）最初的使用，大多依赖于缺乏适当方法的旧有药代动力学（PK）研究。近年来，许多针对动物和人类的PK研究提供了更为一致的证据，支持更好地使用这些宝贵的抗生素。然而，将临床前数据转化为临床实践并非总是易事，有些人可能在如何将多粘菌素的最新知识应用于患者护理方面遇到困难。尽管许多问题仍未得到解决，但在开具多粘菌素B和CMS的初始剂量及维持剂量时，已有一致的数据能够改善临床实践。鉴于优化使用多粘菌素的重要性，这篇社论讨论了近期的PK研究结果，以及如何在床边利用这些结果来改善对广泛耐药革兰氏阴性菌感染患者的治疗。
