Daly Ann K
Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, UK.
Antibiotics (Basel). 2023 Feb 21;12(3):425. doi: 10.3390/antibiotics12030425.
There has been widespread implementation of pharmacogenomic testing to inform drug prescribing in medical specialties such as oncology and cardiology. Progress in using pharmacogenomic tests when prescribing antimicrobials has been more limited, though a relatively large number of pharmacogenomic studies on aspects such as idiosyncratic adverse drug reactions have now been performed for this drug class. Currently, there are recommendations in place from either National Regulatory Agencies and/or specialist Pharmacogenomics Advisory Groups concerning genotyping for specific variants in MT-RNR1 and CYP2C19 before prescribing aminoglycosides and voriconazole, respectively. Numerous additional pharmacogenomic associations have been reported concerning antimicrobial-related idiosyncratic adverse drug reactions, particularly involving specific HLA alleles, but, to date, the cost-effectiveness of genotyping prior to prescription has not been confirmed. Polygenic risk score determination has been investigated to a more limited extent but currently suffers from important limitations. Despite limited progress to date, the future widespread adoption of preemptive genotyping and genome sequencing may provide pharmacogenomic data to prescribers that can be used to inform prescribing and increase the safe use of antimicrobials.
药物基因组学检测已在肿瘤学和心脏病学等医学专科中广泛应用于指导药物处方。在开具抗菌药物时使用药物基因组学检测的进展较为有限，不过目前针对这类药物已经开展了相对大量关于特异质性药物不良反应等方面的药物基因组学研究。目前，国家监管机构和/或专业药物基因组学咨询小组分别针对在开具氨基糖苷类药物和伏立康唑之前对MT - RNR1和CYP2C19特定变体进行基因分型提出了建议。关于抗菌药物相关特异质性药物不良反应，尤其是涉及特定HLA等位基因，已经报道了许多其他药物基因组学关联，但迄今为止，处方前基因分型的成本效益尚未得到证实。多基因风险评分测定的研究程度较为有限，目前存在重要局限性。尽管迄今为止进展有限，但未来预先基因分型和基因组测序的广泛应用可能会为开处方者提供药物基因组学数据，可用于指导处方并提高抗菌药物的安全使用。
