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

New Advances of Polymyxins in the Treatment of Pan Drug Resistant Gram-negative Bacterial Infections

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。

Objective： To explore the related characteristics ofpolymyxin 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 ofnephrotoxicity 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.