多粘菌素对泛耐药革兰阴性杆菌严重感染临床应用新进展.pdfVIP

药学进展 多粘菌素对泛耐药革兰阴性杆菌严重感染临床应用新进展 李然，王睿，李碧艳（解放军总医院临床药理研究室，北京，100853 ） 摘要 目的：了解多粘菌素的相关特点，为制定合理的给药方案，提高临床疗效和安全性提供参考。方法：通过查阅文献，总 结多粘菌素B 及E 的药理学特点、临床应用新进展、不良反应及耐药性，并提出相应的防治对策。结果：多粘菌素类对泛耐 药革兰阴性菌感染，特别对多药耐药的鲍曼不动杆菌和铜绿假单胞菌所致感染有较好疗效。其肾毒性及神经肌肉阻滞反应 的发生率较以前降低。由于多粘菌素类的广泛应用，革兰阴性菌中已出现耐药菌株。结论：多粘菌素类使用时应注意剂量、 与其他药物联用以及肾功能不全患者安全合理使用等问题。 关键词 多粘菌素B ；多粘菌素E ；泛耐药革兰阴性菌；临床应用；不良反应；耐药性 中图分类号：R978.1 文献标识码：A 文章编号：1672 – 8157(2009)06 – 0364 – 04 New Advances of Polymyxins in the Treatment of Pan Drug Resistant Gram-negative Bacterial Infections LI Ran, WANG Rui, LI Bi-yan(Department of Clinical Pharmacology, PLA General Hospital, Beijing, 100853) ABSTRACT Objective: To explore the related characteristics of polymyxin B and E and provide the references for establishing rational schemes and improving clinical efficacy and safety of drug use. Methods: The characteristics of pharmacology, new clinical application, adverse reactions and drug resistance of polymyxin B and E were summarized and the prevention countermeasures were provided by searching the latest literatures. Results: Researches showed that polymyxins were exactly effective for pan drug resistant gram-negative infections, especially pan drug resistant Pseudomonas aeruginosa and Acinetobacter baumannii. The incidence rate of nephrotoxicity and neuromuscular blockade induced by polymyxins were lower than before. There existed resistant mutant in gram-negative due to the abuse of polymyxins. Conclusion: We should pay more attention to the dosage, combination with other antibiotic agents and the reasonable use in renal dysfunction patients when using polymyxins. KEY WORDS Polymyxin B; Polymyxin E; Pan drug resistant gram-negative bacteria; Clinical application; Adverse reaction; Drug resistance 多粘菌素是从多粘杆菌培养液中获得的抗生素， 1 药效学 包括5 种不同的化学成分（多粘菌素A 、B 、C 、D 和 多粘菌素类对多数革兰阴性需氧菌有较强抗菌 E ），仅多粘菌素B 和E