The clinical use of colistin in patients with cystic fibrosis.
The clinical use of colistin in patients with cystic fibrosis.
复制标题
DOI：
10.1097/00063198-200111000-00013
复制
发表时间：
2001-11-01
影响因子：
3.3
通讯作者：
Beringer, P
中科院分区：
文献类型：
--
作者：
Beringer, P
粘菌素是一种来自多粘菌素家族的阳离子多肽抗生素，于 1962 年首次推出，但由于最初报道有严重毒性而在 20 世纪 70 年代初被放弃。然而，最近多重耐药（MDR）铜绿假单胞菌患病率的增加以及开发中新药的缺乏，要求重新审视粘菌素治疗在囊性纤维化患者中的作用。目前的数据支持使用静脉注射粘菌酯来治疗涉及耐多药铜绿假单胞菌的急性肺部恶化，并使用吸入疗法来治疗初始定植。肾毒性的发生频率和神经毒性的严重程度似乎比以前认为的要低得多。此外，最近的药代动力学和药效学数据表明，新的静脉给药方案可以提高疗效，同时最大限度地减少毒性；此类方案值得进一步评估。建议在吸入粘菌素治疗开始时进行治疗前和治疗后肺活量测定，以识别敏感个体。明智地使用粘菌素（其益处已被明确记录）将使其成为治疗囊性纤维化患者铜绿假单胞菌感染的有用药物。
Colistin is a cationic polypeptide antibiotic from the polymyxin family that was first introduced in 1962 but abandoned in the early 1970s because of initial reports of severe toxicities. However, a recent increase in the prevalence of multidrug resistant (MDR) Pseudomonas aeruginosa and the lack of novel agents in development calls for a need to re-examine the role of colistin therapy in patients with cystic fibrosis. Current data supports the use of intravenous colistimethate for the treatment of acute pulmonary exacerbations involving MDR P. aeruginosa and inhaled therapy for initial colonization. The frequency of nephrotoxicity and severity of neurotoxicity seem to be substantially less than previously believed. In addition, recent pharmacokinetic and pharmacodynamic data suggests new intravenous dosing regimens may enhance efficacy while minimizing toxicities; such regimens deserve further evaluation. Pre- and post-treatment spirometry is recommended at initiation of inhaled colistin therapy to identify sensitized individuals. Judicious use of colistin where the benefits have been clearly documented will retain this as a useful agent in the management of P. aeruginosa infections in patients with cystic fibrosis.