Destache Christopher J
Department of Pharmacy Practice, Creighton University Schools of Pharmacy & Health Professions and Medicine, Omaha, NE, USA
J Pharm Pract. 2014 Dec;27(6):562-6. doi: 10.1177/0897190014546102. Epub 2014 Aug 14.
The use of aminoglycoside (AG) antibiotics has declined over the past 15 years primarily due to comparable potency of other antimicrobials and the nephrotoxicity potential of AG drugs. However, resurgence in the use of AG antimicrobials is occurring due to multidrug-resistant gram-negative nosocomial infections. Multidrug-resistant Pseudomonas and Acinetobacter isolates as well as extended-spectrum beta-lactamase-producing Enterobacteriaceae continue to force clinicians to consider AG therapy for nosocomial infections in hospitalized patients and enterococcal endocarditis. Additionally, AGs are still indicated in the treatment of pulmonary exacerbations of cystic fibrosis. Along with the use of AG antibiotics is the associated renal insufficiency complication. This review discusses the mechanism for AG-induced nephrotoxicity. Patient- and drug-related risk factors are discussed to help identify patients at increased risk. The issue of serum-level monitoring is discussed relative to the development of nephrotoxicity.
在过去15年中，氨基糖苷类（AG）抗生素的使用有所减少，主要原因是其他抗菌药物具有相当的效力，以及AG药物存在肾毒性风险。然而，由于多重耐药革兰氏阴性医院感染，AG抗菌药物的使用正在再度兴起。多重耐药的假单胞菌和不动杆菌分离株，以及产超广谱β-内酰胺酶的肠杆菌科细菌，继续迫使临床医生考虑对住院患者的医院感染和肠球菌性心内膜炎采用AG治疗。此外，AG仍用于治疗囊性纤维化的肺部加重期。与使用AG抗生素相伴的是相关的肾功能不全并发症。本综述讨论了AG诱导肾毒性的机制。讨论了患者和药物相关的危险因素，以帮助识别风险增加的患者。还讨论了与肾毒性发生相关的血清水平监测问题。
