Toxicity of polymyxins: a systematic review of the evidence from old and recent studies.
Toxicity of polymyxins: a systematic review of the evidence from old and recent studies.
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DOI：
10.1186/cc3995
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发表时间：
2006-02
期刊：
影响因子：
15.1
通讯作者：
Kasiakou, Sofia K.
中科院分区：
文献类型：
--
作者：
Falagas, Matthew E.;Kasiakou, Sofia K.
多重耐药革兰氏阴性菌引起严重感染的问题日益严重，新的抗生素短缺，导致对多粘菌素的重新评价。这些抗生素是1947年从不同种类的多粘芽孢杆菌中发现的；其中只有多粘菌素B和E（粘菌素）两种已用于临床。它们在治疗由易感革兰氏阴性菌引起的感染方面的有效性，包括铜绿假单胞菌和鲍曼不动杆菌，没有受到普遍质疑。然而，由于担心毒性，除囊性纤维化患者外，它们的使用已被放弃。我们通过检索Pubmed（从1950年到2005年5月）回顾了关于多粘菌素引起的毒性的旧的和最近的证据。据旧文献报道，多粘菌素的使用具有相当大的毒性，主要是肾毒性和神经毒性，包括神经肌肉阻断。然而，最近的研究表明，与以前的研究相比，肾毒性的发生率较低且严重。此外，多粘菌素的神经毒性作用通常是轻微的，并在及时停用抗生素后消退。此外，神经肌肉阻滞和呼吸暂停的病例在最近的文献中没有报道。新的证据表明，多粘菌素的毒性比以前报道的要小。避免同时使用肾毒性和/或神经毒性药物，小心给药，以及对液体和电解质异常的更细致的管理和使用重症监护服务可能是旧文献和最新文献报道数据差异的一些原因。
The increasing problem of multidrug-resistant Gram-negative bacteria causing severe infections and the shortage of new antibiotics to combat them has led to the re-evaluation of polymyxins. These antibiotics were discovered from different species of Bacillus polymyxa in 1947; only two of them, polymyxin B and E (colistin), have been used in clinical practice. Their effectiveness in the treatment of infections due to susceptible Gram-negative bacteria, including Pseudomonas aeruginosa and Acinetobacter baumannii, has not been generally questioned. However, their use was abandoned, except in patients with cystic fibrosis, because of concerns related to toxicity. We reviewed old and recent evidence regarding polymyxin-induced toxicity by searching Pubmed (from 1950 until May 2005). It was reported in the old literature that the use of polymyxins was associated with considerable toxicity, mainly nephrotoxicity and neurotoxicity, including neuromuscular blockade. However, recent studies showed that the incidence of nephrotoxicity is less common and severe compared to the old studies. In addition, neurotoxic effects of polymyxins are usually mild and resolve after prompt discontinuation of the antibiotics. Furthermore, cases of neuromuscular blockade and apnea have not been reported in the recent literature. New evidence shows that polymyxins have less toxicity than previously reported. The avoidance of concurrent administration of nephrotoxic and/or neurotoxic drugs, careful dosing, as well as more meticulous management of fluid and electrolyte abnormalities and use of critical care services may be some of the reasons for the discrepancy between data reported in the old and recent literature.
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DOI：
10.1111/j.1476-5381.1964.tb01610.x
发表时间：
1964-01-01
期刊：
BRITISH JOURNAL OF PHARMACOLOGY AND CHEMOTHERAPY
影响因子：
--
作者：
BARNETT, M;BUSHBY, SRM;WILKINSON, S
通讯作者：
WILKINSON, S
影响因子：
11.4
作者：
BROWN, JM;DORMAN, DC;ROY, LP
通讯作者：
ROY, LP
影响因子：
10
作者：
Conway, SP;Pond, HN;Goldman, MH
通讯作者：
Goldman, MH
影响因子：
4.9
作者：
DANNER, RL;JOINER, KA;PARRILLO, JE
通讯作者：
PARRILLO, JE
影响因子：
--
作者：
DECKER, DA;FINCHAM, RW
通讯作者：
FINCHAM, RW