Daptomycin: an evidence-based review of its role in the treatment of Gram-positive infections.
Daptomycin: an evidence-based review of its role in the treatment of Gram-positive infections.
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DOI：
10.2147/idr.s99046
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发表时间：
2016
影响因子：
3.9
通讯作者：
Hamed K
中科院分区：
文献类型：
--
作者：
Gonzalez-Ruiz A;Seaton RA;Hamed K
革兰氏阳性病原体引起的感染仍然是一个主要的公共卫生负担，并与高发病率和死亡率有关。革兰氏阳性菌感染率的增加和对常用抗生素耐药性的出现导致了对新型抗生素的需求。达托霉素是一种对多种革兰氏阳性菌（包括耐甲氧西林金黄色葡萄球菌）具有快速杀菌活性的环脂肽，已被证明对复杂性皮肤和软组织感染（4 mg/kg/天）、由S.金黄色葡萄球菌，以及与复杂皮肤和软组织感染或右侧感染性心内膜炎相关的菌血症（6 mg/kg/天）。基于其药代动力学特征和浓度依赖性杀菌活性，高剂量（>6 mg/kg/天）达托霉素被认为是管理各种难治性革兰氏阳性菌感染的重要治疗选择。虽然达托霉素耐药性已被记录，但尽管达托霉素的使用越来越多，但仍然不常见。为了增强活性并最大限度地减少耐药性，还探索了达托霉素与其他抗生素的组合，并发现其在某些严重感染中是有益的。达托霉素通过2分钟静脉推注的可用性有利于其门诊给药，提供了降低医疗保健相关感染风险、提高患者满意度和最大限度降低医疗保健成本的机会。达托霉素，目前尚未批准用于儿科人群，已被证明广泛用于治疗儿童革兰氏阳性菌感染。
Infections caused by Gram-positive pathogens remain a major public health burden and are associated with high morbidity and mortality. Increasing rates of infection with Gram-positive bacteria and the emergence of resistance to commonly used antibiotics have led to the need for novel antibiotics. Daptomycin, a cyclic lipopeptide with rapid bactericidal activity against a wide range of Gram-positive bacteria including methicillin-resistant Staphylococcus aureus, has been shown to be effective and has a good safety profile for the approved indications of complicated skin and soft tissue infections (4 mg/kg/day), right-sided infective endocarditis caused by S. aureus, and bacteremia associated with complicated skin and soft tissue infections or right-sided infective endocarditis (6 mg/kg/day). Based on its pharmacokinetic profile and concentration-dependent bactericidal activity, high-dose (>6 mg/kg/day) daptomycin is considered an important treatment option in the management of various difficult-to-treat Gram-positive infections. Although daptomycin resistance has been documented, it remains uncommon despite the increasing use of daptomycin. To enhance activity and to minimize resistance, daptomycin in combination with other antibiotics has also been explored and found to be beneficial in certain severe infections. The availability of daptomycin via a 2-minute intravenous bolus facilitates its outpatient administration, providing an opportunity to reduce risk of health care-associated infections, improve patient satisfaction, and minimize health care costs. Daptomycin, not currently approved for use in the pediatric population, has been shown to be widely used for treating Gram-positive infections in children.