Antimikrobiyal İlaçlar
Özet
Yoğun bakım ünitelerinde dirençli mikroorganizmaların yol açtığı enfeksiyonlarla mücadelede, el hijyeni başta olmak üzere enfeksiyon kontrol önlemlerine uyum ve akılcı antibiyotik kullanımı son derece kritik bir öneme sahiptir. Bu ünitelerde en sık tercih edilen antimikrobiyal ilaç grupları detaylı şekilde sınıflandırılmıştır. Geniş spektrumlu beta-laktam grubundan piperasilin/tazobaktam, farklı kuşaklardaki sefalosporinler (özellikle 3, 4 ve 5. kuşaklar) ve geniş spektrumlu karbapenemler (imipenem, meropenem, ertapenem) klinik tedavide sıkça kullanılır. Dirençli gram-pozitif enfeksiyonların kontrolünde hücre duvarı sentezini inhibe eden vankomisin ve hücre membranını bozan daptomisin gibi glikopeptit ve lipopeptit grubu ilaçlar öne çıkmaktadır. Protein sentezini engelleyerek etki gösteren bakterisidal aminoglikozitler (gentamisin, amikasin), geniş spektrumlu bakteriyostatik glisilsiklinler (tigesiklin) ve oksazolidinonlar (linezolid) diğer önemli tedavi seçeneklerini oluşturur. Çoklu ilaca dirençli gram-negatif patojenlerin tedavisinde ise bakterisidal etkili polimiksin B ve kolistin kullanılmaktadır. İnvaziv mantar enfeksiyonlarının tedavisinde ise geniş spektrumlu poliyenler (lipozomal amfoterisin B), azoller (flukonazol, vorikonazol) ve insan hücrelerine toksik etkisi bulunmayan ekinokandinler (kaspofungin, anidulafungin, mikafungin) mantar hücre duvarı sentezini engelleyerek etkili bir tedavi sunmaktadır.
In intensive care units, compliance with infection control measures, particularly hand hygiene, and the rational use of antibiotics are highly critical in combating infections caused by resistant microorganisms. The most frequently preferred antimicrobial drug groups in these units are classified in detail. Piperacillin/tazobactam from the broad-spectrum beta-lactam group, cephalosporins of different generations (especially 3rd, 4th, and 5th generations), and broad-spectrum carbapenems (imipenem, meropenem, ertapenem) are frequently used in clinical treatment. In the control of resistant gram-positive infections, glycopeptide and lipopeptide group drugs, such as vancomycin, which inhibits cell wall synthesis, and daptomycin, which disrupts the cell membrane, stand out. Bactericidal aminoglycosides (gentamicin, amikacin) acting by inhibiting protein synthesis, broad-spectrum bacteriostatic glycylcyclines (tigecycline), and oxazolidinones (linezolid) constitute other important treatment options. For the treatment of multidrug-resistant gram-negative pathogens, bactericidal polymyxin B and colistin are utilized. In the treatment of invasive fungal infections, broad-spectrum polyenes (liposomal amphotericin B), azoles (fluconazole, voriconazole), and echinocandins (caspofungin, anidulafungin, micafungin), which have no toxic effects on human cells, provide effective treatment by preventing fungal cell wall synthesis.
Referanslar
Doi Y, Chambers HF. Penicillins and β-Lactamase Inhibitors In Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases : Elsevier Inc. 2014: 263-277.
Perry CM, Markham A. Piperacillin/tazobactam: an updated review of its use in the treatment of bacterial infections. Drugs. 1999;57(5):805-43
G Bonfiglio, Y Laksai, N Franceschini et al.: In vitro activity of piperacillin/tazobactam against 615 Pseudomonas aeruginosa strains isolated in intensive care units. Chemotherapy. 1998;44:305-312
MD Lyon, KR Smith, MS Saag, et al. In vitro activity of piperacillin, ticarcillin, and mezlocillin alone and in combination with aminoglycosides against Pseudomonas aeruginosa . Antimicrob Agents Chemother. 1986;30:25-30
CM Flynn, DM Johnson, RN Jones: In vitro efficacy of levofloxacin alone or in combination tested against multi-resistant Pseudomonas aeruginosa strains. J Chemother. 1996;8:411-415
G Capellier, C Cornette, A Boillot, et al.: Removal of piperacillin in critically ill patients undergoing continuous venovenous hemofiltration. Crit Care Med. 1998;26:88-91
A.J. Lepak Andes DR. Cephalosporins. J.E. Bennet (Ed.), Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases 9th ed. :Elsevier Inc: 2020: 268-284
Klein NC, Cunha BA. Third-generation cephalosporins. Med Clin North Am 1995; 79(4):705.
GG Zhanel, CD Lawson, H Adam et al. : Ceftazidime-avibactam: a novel cephalosporin/β-lactamase inhibitor combination. Drugs. 2013;73(2):159-177
Lagace-Wiens, F Tailor, P Simner, et al.: Activity of NXL104 in combination with beta-lactams against genetically characterized Escherichia coli and Klebsiella pneumoniae isolates producing class A extended-spectrum beta-lactamases and class C beta-lactamases. Antimicrob Agents Chemother. 2011; 55:2434-2437
Sanders WE Jr, Tenney JH, Kessler RE. Efficacy of cefepime in the treatment of infections due to multiply resistant Enterobacter species. Clin Infect Dis 1996; 23(3):454.
File TM Jr, Wilcox MH, Stein GE. Summary of ceftaroline fosamil clinical trial studies and clinical safety. Clin Infect Dis 2012; 55 Suppl 3:S173
Doi Y. Ertapenem, Imipenem, Meropenem, Doripenem, and Aztreonam, In: Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, Elseviver. 2020:285-90
Papp-Wallace KM, Endimiani A, Taracila MA, Bonomo RA. Carbapenems: past, present, and future. Antimicrob Agents Chemother. 2011;55(11):4943-60.
Murray, Barbara E. et al. “Glycopeptides (Vancomycin and Teicoplanin), Streptogramins (Quinupristin-Dalfopristin), Lipopeptides (Daptomycin), and Lipoglycopeptides (Telavancin).” Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases 2015:377-400.
Safdar N, Andes D, Craig WA. In vivo pharmacodynamic activity of daptomycin. Antimicrob Agents Chemother. 2004:48(1): 63-8.
Vilay MA, Grio M, DePestel DD, et al, “Daptomycin Pharmacokinetics in Critically Ill Patients Receiving Continuous Venovenous Hemodialysis,” Crit Care Med, 2011: 39(1):19-25.
Cubicin (daptomycin) [product monograph]. Mississauga, Ontario, Canada: Sunovion Pharmaceuticals Canada Inc; August 2013.
Mandell GL, Bennett JE, Dolin R. Aminoglycosides. In: Principles and Practice of Infectious Diseases (6th Ed). New York: Churchill Livingstone: 2005.
Kumana CR, Yuen KY. Parenteral aminoglycoside therapy. Selection, administration and monitoring. Drugs 1994:47(6):902.
Stein GE, Craig WA. Tigecycline: a critical analysis. Clin Infect Dis 2006:43(4):518.
US Food and Drug Administration (FDA). FDA drug safety communication: Increased risk of death with Tygacil (tigecycline) compared to other antibiotics used to treat similar infections. http://www.fda.gov/Drugs/DrugSafety/ucm224370.htm (Accessed on September 02, 2010).
Moellering RC. Linezolid: the first oxazolidinone antimicrobial. Ann Intern Med 2003: 139(10):135.
Nation RL, Velkov T, Li J. Colistin and polymyxin B: peas in a pod, or chalk and cheese? Clin Infect Dis 2014:59(1):88.
Kucers Alvis, Crowe SM, Grayson ML et al. The Use of Antibiotics: A Clinical Review of Antibacterial, Antifungal, Antiparasitic, and Antiviral Drugs, (7th ed). Boca Raton: CRC Press; 2018. p.1420.
Dismukes WE. Antifungal therapy: lessons learned over the past 27 years. Clin Infect Dis 2006:42(9):1289.
Pappas PG, Kauffman CA, Andes DR, et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis 2016:62(4):e1.
Centers for Disease Control and Prevention. Clinical Alert to U.S. Healthcare Facilities - June 2016 | Fungal Diseases | CDC. Fungal Diseases. http://www.cdc.gov/fungal/diseases/candidiasis/candida-auris-alert.html. Published 2016(Accessed september 2021).
American Society of Health System Pharmacists, Inc., DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. 233400, Fluconazole; [updated 2011 Aug 03, cited 2017 Dec 13]; [about 45 screens]. Available from http://search.ebscohost.com/login.aspx?direct=true&db=dnh&AN=233400&site=dynamed-live&scope=site.
Carrillo-Munoz AJ, Giusiano G, Ezkurra PA, Quindos G. Antifungal agents: mode of action in yeast cells. Rev Esp Quimioter 2006;19(2):130-139.
Denning DW. Echinocandin antifungal drugs. Lancet 2003;362(9390):1142-1151
Maschmeyer G, Glasmacher A. Pharmacological properties and clinical efficacy of a recently licensed systemic antifungal, caspofungin. Mycoses 2005; 48(4): 227-234.
Chandrasekar PH, Sobel JD. Micafungin: a new echinocandin. Clin Infect Dis 2006; 42(8): 1171-1178
Mora-Duarte J, Betts R, Rotstein C, et al. Comparison of caspofungin and amphotericin B for invasive candidiasis. N Engl J Med 2002; 347(25):2020–2029.
Reboli AC, Rotstein C, Pappas PG, et al. Anidulafungin versus fluconazole for invasive candidiasis. N Engl J Med 2007;356(24):2472–82.
Kuse ER, Chetchotisakd P, da Cunha CA, et al. Micafungin versus liposomal amphotericin B for candidaemia and invasive candidosis: a phase III randomised double-blind trial. Lancet 2007; 369(9572):1519–1527.
