Macrolides for the treatment of Pseudomonas aeruginosa infections?
Macrolides for the treatment of Pseudomonas aeruginosa infections?
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DOI：
10.1093/jac/40.2.153
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发表时间：
1997-08-01
影响因子：
5.2
通讯作者：
Spencer, RC
中科院分区：
文献类型：
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作者：
Howe, RA;Spencer, RC
进行体外药敏试验，以预测不同抗生素对特定感染的临床疗效。当在感染部位达到的抗生素浓度等于或超过该生物体的MIC时，通常认为该生物体对抗生素敏感。Lorian和Burns在1990年1指出，在体外，用感染微生物敏感的抗生素治疗的患者比用微生物耐药的抗生素治疗的患者有更好的结果。大环内酯类药物对大多数铜绿假单胞菌菌株的MIC范围为128-512 mg/L。然而，口服250 mg红霉素后的血清峰浓度仅为1.0-1.5 mg/L，在一项研究中，每12小时静脉注射1 g红霉素后的平均痰液浓度为2.6 mg/L。2因此，根据常规标准判断，铜绿假单胞菌对大环内酯类耐药。然而，越来越多的证据表明大环内酯类在治疗某些假单胞菌感染中的作用。在1982年观察到弥漫性泛细支气管炎（DPB）患者在长期大环内酯类药物治疗期间病情有所改善后，对这一领域的兴趣开始增加。3 DPB是一种慢性肺部疾病，几乎仅在日本描述，在临床和细菌学上与囊性纤维化相似。4、5嗜血杆菌初次感染
In-vitro susceptibility testing is performed in order to predict the clinical efficacy of different antibiotics for a given infection. An organism is usually said to be sensitive to an antibiotic when the antibiotic concentration achieved at the site of infection is equal to, or exceeds, the MIC for that organism. Lorian & Burns1 showed in 1990 that patients treated with antibiotics to which the infecting organism was sensitive had a much better outcome than those treated with antibiotics to which the organism was resistant in vitro.The MIC of macrolides for most Pseudomonas aeruginosa strains is in the range 128–512 mg/L. Peak serum concentrations of erythromycin after a 250 mg oral dose are, however, only 1.0–1.5 mg/L and in one study the mean sputum concentration after an intravenous dose of 1 g every 12 h was 2.6 mg/L. 2 Thus, judged by conventional criteria, P. aeruginosa is resistant to the macrolides. However, there is increasing evidence of a role for macrolides in the treatment of certain pseudomonal infections. Interest in this area followed the observation in 1982 that patients suffering from diffuse panbronchiolitis (DPB) improved during long-term macrolide treatment. 3 DPB is a chronic lung disease, described almost exclusively in Japan, that is clinically and bacteriologically similar to cystic fibrosis. 4, 5 Initial infections with Haemophilus