粘菌素
多粘菌素
抗生素
药理学
多粘菌素B
化学
微生物学
最小抑制浓度
药代动力学
肾毒性
脂质A
医学
毒性
生物
免疫学
脂多糖
内科学
作者
Anneke C. Dijkmans,Erik B. Wilms,Ingrid M. C. Kamerling,Willem Birkhoff,Natalia V. Ortiz Zacarı́as,Cees van Nieuwkoop,Henri A. Verbrugh,Daan J. Touw
出处
期刊:Therapeutic Drug Monitoring
[Ovid Technologies (Wolters Kluwer)]
日期:2015-08-01
卷期号:37 (4): 419-427
被引量:56
标识
DOI:10.1097/ftd.0000000000000172
摘要
Colistin (polymyxin E) is a positively charged deca-peptide antibiotic that disrupts the integrity of the outer membrane of the cell wall of gram-negative bacteria by binding to the lipid A moiety of lipopolysaccharides, resulting in cell death. The endotoxic activity of lipopolysaccharides is simultaneously inhibited. Colistin is increasingly being prescribed as rescue treatment for infections with multidrug-resistant bacilli. Nephrotoxicity and, to a lesser degree, neurotoxicity occur often during systemic colistin therapy, and have severely limited its application in the past. However, these side effects are largely reversible and can be managed through close monitoring. The prodrug colistimethate sodium (CMS) is less toxic and is, therefore, the preferred formulation for parenteral administration. Importantly, resistance to colistin seems to emerge often unless it is combined with another antibiotic, but further studies into this phenomenon are necessary. Pharmacokinetic and pharmacodynamic properties have received little attention, partly because of the physicochemical peculiarities of polymyxin antibiotics, especially their propensity to stick to other molecules and surfaces. The ratio between the area under the curve of free colistin and the pathogen's Minimal Inhibitory Concentration (MIC) best predicts microbiological and clinical responses, but more studies are needed in this area. Likewise, further standardization is needed in production and labeling of colistin formulations, and in the way the susceptibility of bacteria to colistin is determined.
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