School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, State University of New York, Buffalo, New York.
Detroit Medical Center, Detroit, Michigan.
Pharmacotherapy. 2019 Jan;39(1):10-39. doi: 10.1002/phar.2209.
The polymyxin antibiotics colistin (polymyxin E) and polymyxin B became available in the 1950s and thus did not undergo contemporary drug development procedures. Their clinical use has recently resurged, assuming an important role as salvage therapy for otherwise untreatable gram-negative infections. Since their reintroduction into the clinic, significant confusion remains due to the existence of several different conventions used to describe doses of the polymyxins, differences in their formulations, outdated product information, and uncertainties about susceptibility testing that has led to lack of clarity on how to optimally utilize and dose colistin and polymyxin B. We report consensus therapeutic guidelines for agent selection and dosing of the polymyxin antibiotics for optimal use in adult patients, as endorsed by the American College of Clinical Pharmacy (ACCP), Infectious Diseases Society of America (IDSA), International Society of Anti-Infective Pharmacology (ISAP), Society for Critical Care Medicine (SCCM), and Society of Infectious Diseases Pharmacists (SIDP). The European Society for Clinical Microbiology and Infectious Diseases (ESCMID) endorses this document as a consensus statement. The overall conclusions in the document are endorsed by the European Committee on Antimicrobial Susceptibility Testing (EUCAST). We established a diverse international expert panel to make therapeutic recommendations regarding the pharmacokinetic and pharmacodynamic properties of the drugs and pharmacokinetic targets, polymyxin agent selection, dosing, dosage adjustment and monitoring of colistin and polymyxin B, use of polymyxin-based combination therapy, intrathecal therapy, inhalation therapy, toxicity, and prevention of renal failure. The treatment guidelines provide the first ever consensus recommendations for colistin and polymyxin B therapy that are intended to guide optimal clinical use.
多黏菌素类抗生素黏菌素（多黏菌素 E）和多黏菌素 B 于 20 世纪 50 年代问世，因此未经历当代药物开发程序。由于它们作为其他无法治疗的革兰氏阴性感染的挽救性治疗药物重新应用于临床，其临床应用最近再次兴起。自重新引入临床以来，由于存在几种不同的描述多黏菌素剂量的惯例、它们的配方差异、过时的产品信息以及对药敏试验的不确定性，导致在如何最佳利用和给药黏菌素和多黏菌素 B 方面仍存在很大的混淆。我们报告了美国临床药学学院（ACCP）、美国传染病学会（IDSA）、国际抗感染药理学学会（ISAP）、重症监护医学学会（SCCM）和感染性疾病药师学会（SIDP）认可的共识治疗指南，用于指导成年患者选择和给药多黏菌素类抗生素，以实现最佳使用。欧洲临床微生物学和传染病学会（ESCMID）作为共识声明认可了这一文件。文件中的总体结论得到了抗菌药物敏感性测试欧洲委员会（EUCAST）的认可。我们成立了一个多元化的国际专家小组，就药物的药代动力学和药效学特性以及药代动力学目标、多黏菌素类药物选择、剂量、剂量调整和黏菌素和多黏菌素 B 的监测、多黏菌素类联合治疗的应用、鞘内治疗、吸入治疗、毒性以及预防肾衰竭等方面提出治疗建议。这些治疗指南提供了有史以来首次关于黏菌素和多黏菌素 B 治疗的共识建议，旨在指导最佳临床应用。
