Levin S, Karakusis P H
Am J Med. 1986 Jun 30;80(6B):190-4. doi: 10.1016/0002-9343(86)90500-0.
The aminoglycosidic aminocyclitols have been utilized extensively for three decades. Nonetheless, the future use of this class of agents has been questioned of late. Recognized inadequacies of the aminoglycosides and the development of new antibiotics with significant activity against gram-negative bacilli are commonly cited reasons for the theorized decline of these compounds. However, resistance to newly developed antibiotics already has become evident. This insures a continuing role for the aminoglycosides in the treatment of nosocomial infections. Aminoglycosides will have continued use as empiric, potentially synergistic therapies for hospital-acquired infections in neutropenic patients with bacteremia, in enterococcal endovascular infections, and in patients with serious infections associated with Pseudomonas aeruginosa. Those factors that will influence the future role of aminoglycosides in these settings will include economic, administrative, and space pressures to restrict the number of antibiotics available in hospitals, the discovery of novel antibiotics, the utility of combination therapies employing an aminoglycoside and newly available drugs, the comparative toxicities of new antimicrobial regimens, and considerations of cost containment.
氨基糖苷类氨基环醇已被广泛应用了三十年。然而，近来这类药物的未来使用受到了质疑。氨基糖苷类药物公认的不足之处以及对革兰氏阴性杆菌具有显著活性的新抗生素的研发，是这些化合物理论上用量下降的常见原因。然而，对新开发抗生素的耐药性已经很明显。这确保了氨基糖苷类药物在医院感染治疗中继续发挥作用。氨基糖苷类药物将继续作为经验性的、可能具有协同作用的疗法，用于治疗患有菌血症的中性粒细胞减少患者的医院获得性感染、肠球菌心内膜感染以及与铜绿假单胞菌相关的严重感染患者。那些将影响氨基糖苷类药物在这些情况下未来作用的因素将包括限制医院可用抗生素数量的经济、管理和空间压力、新型抗生素的发现、采用氨基糖苷类药物和新可用药物的联合疗法的效用、新抗菌方案的相对毒性以及成本控制方面的考虑。
