吸入性抗菌药物在囊性纤维化长期管理中的应用

Application of Inhaled Antibiotics in the Long-Term Management of Cystic Fibrosis

吸入性抗菌药物治疗可以提高靶点浓度和优化药动学/药效学指标,同时减少全身性暴露,在国外已用于囊性纤维化(cysticfibrosis,CF)、非CF支气管扩张以及呼吸机相关性肺炎的治疗研究。铜绿假单胞菌(Pseudomonas aeruginosa,Pa)是CF常见病原菌,可引起肺疾病的急性加重、肺功能加速恶化和降低生存率,首选治疗为吸入性抗菌药物。目前,我国尚没有吸入性抗菌药物制剂上市,影响了CF的临床治疗和管理。妥布霉素注射液的说明书中有记载气道局部用法,其雾化吸入用于治疗CF合并Pa感染在国内已有应用经验,国外也对妥布霉素注射液的有效性和安全性有了初步的研究,提示其可能成为现阶段我国药物可及的一种可接受的、暂时的替代。随着我国报道的CF病例逐年增多,吸入性抗菌药物在CF长期管理中的重要性应该得到重视。

The use of inhaled antimicrobial therapy can improve target concentration and optimize pharmacokinetic/pharmacodynamic(PK/PD)indexes,while reducing systemic exposure.It has been used in cystic fibrosis(CF),non-CF-associated bronchiectasis,and ventilator-associated pneumonia abroad.Infection with Pseudomonas aeruginosa(Pa)is common in CF,which causes acute pulmonary exacerbations,accelerated deterioration of pulmonary function,and reduced survival rate.Inhalation antibiotics are the first choice for treatment.At present,there are no inhaled antibiotics on the market in China,which seriously affects the clinical treatment and management of CF.The local airway usage of tobramycin injection is recorded in the instruction manual,and its atomization inhalation for the treatment of CF complicated with Pa infection has been used in China.And there have been preliminary studies on its efficacy and safety abroad,suggesting that tobramycin injection may become an acceptable and temporary alternative in China at this stage.With the increase of CF cases reported year by year in China,the importance of inhaled antibiotics in the long-term management of CF should be paid more attention.