a Department of Applied Biology and Chemical Technology, State Key Laboratory of Chirosciences , The Hong Kong Polytechnic University , Hong Kong , P.R. China.
b Department of Medicine and Therapeutics, School of Biomedical Sciences, MOE Key Laboratory for Regenerative Medicine , The Chinese University of Hong Kong , Hong Kong , P.R. China.
Crit Rev Microbiol. 2018 Feb;44(1):40-78. doi: 10.1080/1040841X.2017.1313811. Epub 2017 Apr 19.
Antimicrobial resistance of disease-related microorganisms is considered a worldwide prevalent and serious issue which increases the failure of treatment outcomes and leads to high mortality. Considering that the increased resistance to systemic antimicrobial therapy often needs of the use of more toxic agents, topical antimicrobial therapy emerges as an attractive route for the treatment of infectious diseases. The topical antimicrobial therapy is based on the absorption of high drug doses in a readily accessible skin surface, resulting in a reduction of microbial proliferation at infected skin sites. Topical antimicrobials retain the following features: (a) they are able to escape the enzymatic degradation and rapid clearance in the gastrointestinal tract or the first-pass metabolism during oral administration; (b) alleviate the physical discomfort related to intravenous injection; (c) reduce possible adverse effects and drug interactions of systemic administrations; (d) increase patient compliance and convenience; and (e) reduce the treatment costs. Novel antimicrobials for topical application have been widely exploited to control the emergence of drug-resistant microorganisms. This review provides a description of antimicrobial resistance, common microorganisms causing skin and soft tissue infections, topical delivery route of antimicrobials, safety concerns of topical antimicrobials, recent advances, challenges and future prospective in topical antimicrobial development.
疾病相关微生物的抗药性被认为是一个全球性普遍存在且严重的问题，它增加了治疗失败的风险，并导致高死亡率。由于对抗全身抗菌治疗的耐药性增加，通常需要使用更具毒性的药物，局部抗菌治疗作为治疗传染病的一种有吸引力的途径出现了。局部抗菌治疗是基于在易于接近的皮肤表面吸收高剂量药物，从而减少感染皮肤部位的微生物增殖。局部抗菌药物具有以下特点：(a) 它们能够逃避胃肠道中的酶降解和快速清除，或在口服给药时的首过代谢；(b) 缓解与静脉注射相关的身体不适；(c) 减少全身给药的可能不良反应和药物相互作用；(d) 提高患者的依从性和便利性；(e) 降低治疗成本。已经广泛开发了用于控制耐药微生物出现的新型局部应用抗菌药物。本文综述了抗菌药物耐药性、引起皮肤和软组织感染的常见微生物、抗菌药物的局部给药途径、局部抗菌药物的安全性问题、最新进展、挑战以及局部抗菌药物开发的未来前景。
