The safety of polymyxin antibiotics.
The safety of polymyxin antibiotics.
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DOI：
10.1517/14740338.2015.1088520
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发表时间：
2015
影响因子：
3.1
通讯作者：
Falagas ME
中科院分区：
文献类型：
--
作者：
Kelesidis T;Falagas ME
多重耐药革兰氏阴性菌的出现导致多粘菌素的使用越来越多。在全身多粘菌素治疗期间，经常发生肾毒性和较低程度的神经毒性。关于多粘菌素安全性的科学证据仍然有限。对评估多粘菌素安全性和毒性的病例报告/病例系列、观察性研究和临床试验进行了严格审查。多粘菌素是治疗范围较窄的药物。肾毒性与宿主因素和多粘菌素暴露相关，最近的研究表明，粘菌素和多粘菌素B的肾毒性相对风险相似。研究多粘菌素的安全性有几个局限性。考虑到现有证据，多粘菌素治疗期间可能发生的毒性通常为轻度至中度，性质可逆。已经发展了使与多粘菌素相关的毒性最小化的策略，包括避免毒性药物、谨慎给药、使用重症监护、治疗药物监测和多粘菌素衍生物的开发。然而，鉴于多粘菌素的使用在抗生素耐药性增加的时代重新出现，其他治疗方式的存在可能是有限的。因此，临床医生必须考虑继续与停止多粘菌素治疗的总体风险获益比，并优化最小化策略以减少多粘菌素诱导的毒性。
The emergence of multidrug-resistant gram-negative bacteria has led to the increasing use of polymyxins. Nephrotoxicity and, to a lesser degree, neurotoxicity occur often during systemic polymyxin therapy. Scientific evidence regarding safety associated with polymyxins remains limited. Case reports/case series, observational studies and clinical trials assessing safety and toxicity of polymyxins were critically reviewed. Polymyxins are drugs with a narrow therapeutic range. Nephrotoxicity is associated with both host factors and polymyxin exposure, and recent studies suggest that the relative risk of nephrotoxicity is similar for colistin and polymyxin B. Studies that have examined the safety of polymyxins have several limitations. Considering the available evidence, toxicities that may develop while on polymyxin therapy most often are mild to moderate in magnitude and reversible in nature. Strategies to minimize toxicity associated with polymyxins have evolved and include avoidance of toxic medications, careful dosing, use of critical care, therapeutic drug monitoring and development of polymyxin derivatives. However, given that polymyxin use has re-emerged in an era of increased antimicrobial resistance, the presence of other treatment modalities may be limited. Therefore, clinicians must consider overall risk to benefit ratio of continuing versus stopping polymyxin treatment and optimize minimization strategies to reduce polymyxin-induced toxicities.