临床使用的氨基糖苷类抗生素：循证医学的探讨

David

JAC Advance Access published online on November 19, 2008
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkn469

Review


Aminoglycoside drugs in clinical practice: an evidence-based approach
临床使用的氨基糖苷类抗生素：循证医学的探讨
Leonard Leibovici1,2,*, Liat Vidal1,2 and Mical Paul1,2,3
1 Department of Medicine E, Beilinson Campus, Petah-Tiqva 49100, Israel 2 Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Tel-Aviv, Israel 3 The Infectious Diseases Unit, Beilinson Campus, Rabin Medical Center, Petah-Tiqva 49100, Israel



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* Corresponding author. Tel: +972-3-9376501; Fax: +972-3-9376512; E-mail: leibovic@post.tau.ac.il
Resistant bacteria have renewed our interest in the aminoglycoside drugs. Evidence on the efficiency of aminoglycosides in their different clinical uses is available from numerous randomized controlled trials and has been accrued and examined in recent systematic reviews and meta-analyses. Their results show that aminoglycosides should not be added to broad-spectrum β-lactams to achieve synergism in treating Gram-negative infections as combination does not improve efficacy and adds side effects. The evidence from randomized trials in humans does not support the use of aminoglycosides in staphylococcal or streptococcal endocarditis, and is lacking for endocarditis caused by enterococci. Aminoglycosides are efficacious and safe as single drugs for the treatment of pyelonephritis and sepsis of a urinary source, but their efficacy might be lower than that of β-lactams in Gram-negative infections of other sources. In patients with no risk factors, aminoglycosides are as safe as β-lactams regarding side effects. They probably induce less resistance. Pragmatic large trials are needed to answer open clinical questions on the use of aminoglycosides.

Key Words: aminoglycosides , synergism , β-lactams , evidence-based medicine