Dijkmans Anneke C, Wilms Erik B, Kamerling Ingrid M C, Birkhoff Willem, van Nieuwkoop Cees, Verbrugh Henri A, Touw Daan J
Medisch Centrum Haaglanden, afd. Medisch Microbiologie, Den Haag.
Ned Tijdschr Geneeskd. 2014;158:A7445.
Colistin (polymyxin E) binds to the cell wall of gram-negative bacteria, leading to osmotic destruction of the cell. Since its introduction in 1959, colistin has been little used parenterally due to a high incidence of reversible nephrotoxicity and, to a lesser extent, neurotoxicity. Colistin use remained limited to combating Pseudomonas aeruginosa in cystic fibrosis patients. In addition, oral colistin is part of the recently introduced regime of selective digestive tract decontamination in ICU patients. Intravenous administration of colistin is now increasingly prescribed for the control of multi-resistant microorganisms. Colistin monotherapy, however, rapidly selects resistant subpopulations. Therefore, only combination therapy is advised. The prodrug colistimethate sodium is less toxic and is hydrolyzed in vivo to active colistin; colistin is renally cleared. Clinical practice remains hampered by lack of uniformity and standardization of names, dosage units, dosing recommendations and methods of concentration and susceptibility testing.
黏菌素（多黏菌素E）与革兰氏阴性菌的细胞壁结合，导致细胞的渗透性破坏。自1959年被引入以来，由于可逆性肾毒性发生率较高，且在较小程度上存在神经毒性，黏菌素很少通过肠胃外途径使用。黏菌素的使用仍仅限于治疗囊性纤维化患者的铜绿假单胞菌感染。此外，口服黏菌素是重症监护病房患者最近采用的选择性消化道去污方案的一部分。现在，静脉注射黏菌素越来越多地被用于控制多重耐药微生物。然而，黏菌素单一疗法会迅速筛选出耐药亚群。因此，仅建议采用联合疗法。前药黏菌素甲磺酸钠毒性较小，在体内水解为活性黏菌素；黏菌素经肾脏清除。名称、剂量单位、给药建议以及浓度和药敏试验方法缺乏统一性和标准化，这仍然阻碍着临床实践。
