Quinupristin / dalfopristin:回顾它的使用在严重的革兰氏阳性感染的管理。

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羔羊嗯,Figgitt DP, Faulds D

Quinupristin / dalfopristin:回顾它的使用在严重的革兰氏阳性感染的管理。

药。1999年12月,58 (6):1061 - 97。

PubMed ID
10651391 (在PubMed
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文摘

Quinupristin / dalfopristin是第一个肠外streptogramin抗菌剂,并且是30:70 (w / w)的比率2半合成原始霉素衍生物。结合对多种革兰氏阳性细菌抑制活动包括耐甲氧西林葡萄球菌、vancomycin-resistant肠球菌都有效(VREF)耐药肺炎链球菌,其他链球菌、梭状芽孢杆菌perfringens和消化链球菌属spp。结合也有很好的活动对选定的革兰氏阴性呼吸道病原体包括莫拉克斯氏菌属复活,Legioniella瞭解和肺炎支原体。对粪大肠Quinupristin / dalfopristin可怜的活动。结合杀菌对葡萄球菌和链球菌,尽管本构红霉素抗性可以影响其活动。至于其他代理,quinupristin / dalfopristin通常是抑菌与大肠都有效。患者耐甲氧西林金黄色葡萄球菌(MRSA)感染或VREF参与未来的应急使用试验,quinupristin / dalfopristin 7.5毫克/公斤每8或12小时达到临床细菌>或成功= 64%的病人。quinupristin耐药性的出现/ dalfopristin常见(4%的患者)在那些VREF感染。Quinupristin / dalfopristin 7.5毫克/公斤8 - 12小时也实现了类似的临床成功率比较器代理假定革兰氏阳性患者复杂的皮肤和皮肤结构感染或院内肺炎(管理结合aztreoman) 3大型多中心随机试验。系统性与quinupristin相关不良事件/ dalfopristin包括胃肠道事件(恶心、呕吐和腹泻),皮疹和瘙痒。肌痛和关节痛也发生的总发病率为1.3%,尽管更高的利率已报告(2.5 - 31%)患者的多种并发症。 Venous events are common if the drug is administered via a peripheral line; however, several management options (e.g. use of central venous access, increased infusion volume) may help to minimise their occurrence. Hyperbilirubinaemia has been documented in 3.1% of quinupristin/dalfopristin recipients versus 1.3% of recipients of comparator agents. Quinupristin/dalfopristin inhibits cytochrome P450 3A4 and therefore has the potential to increase the plasma concentrations of substrates of this enzyme. CONCLUSIONS: Quinupristin/dalfopristin, the first parenteral streptogramin, offers a unique spectrum of activity against multidrug-resistant gram-positive bacteria. In serious gram-positive infections for which there are other treatment options available, the spectrum of activity and efficacy of quinupristin/ dalfopristin should be weighed against its tolerability and drug interaction profile. However, in VREF or unresponsive MRSA infections, where few proven treatment options exist, quinupristin/dalfopristin should be considered as a treatment of choice for these seriously ill patients.

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药物
药物酶
药物 酶 类 生物 药理作用 行动
Dalfopristin 细胞色素P450 3 a4 蛋白质 人类
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