Abstract

Introduction

Streptogramins (pristinamycin and quinupristin-dalfopristin) can be interesting options for the treatment of infections due to Gram-positive cocci, especially multidrug-resistant isolates.

Areas covered

This review provides an updated overview on structural and activity characteristics, mechanisms of action and resistance, pharmacokinetic/pharmacodynamic and clinical use of streptogramins.

Expert opinion

The streptogramin antibiotics act by inhibition of the bacterial protein synthesis. They are composed of two chemically distinct compounds, namely type A and type B streptogramins, which exert a rapid bactericidal activity against a wide range of Gram-positive bacteria (including methicillin-resistant staphylococci and vancomycin-resistant enterococci). Several mechanisms of resistance have been identified in staphylococci and enterococci but the prevalence of streptogramin resistance among clinical isolates remains very low. Even if only a few randomized clinical trials have been conducted, the efficacy of pristinamycin has been largely demonstrated with an extensive use for 50 years in France and some African countries. Despite its effectiveness in the treatment of severe Gram-positive bacterial infections demonstrated in several studies and the low rate of reported resistance, the clinical use quinupristin-dalfopristin has remained limited, mainly due to its its poor tolerance. Altogether, streptogramins (especially pristinamycin) can be considered as potential alternatives for the treatment of Gram-positive infections.

中文翻译：

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链霉素治疗革兰氏阳性病原体引起的感染

摘要

介绍

链霉菌素（普瑞司他霉素和奎奴普丁-达福普汀）可能是治疗革兰氏阳性球菌引起的感染的有趣选择，尤其是耐多药分离株。

覆盖区域

这篇综述提供了有关链蛋白的结构和活性特征，作用和抵抗机制，药代动力学/药效学和临床应用的最新概述。

专家意见

链霉菌素类抗生素通过抑制细菌蛋白质的合成起作用。它们由两种化学上不同的化合物组成，即A型和B型链霉菌素，它们对多种革兰氏阳性细菌（包括耐甲氧西林的葡萄球菌和耐万古霉素的肠球菌）具有快速的杀菌活性。在葡萄球菌和肠球菌中已经发现了几种耐药机制，但是临床分离株中链霉菌素耐药的发生率仍然很低。即使仅进行了一些随机临床试验，在法国和一些非洲国家，普瑞霉素的疗效已得到广泛应用，并已广泛使用了50年。尽管几项研究表明其可有效治疗严重的革兰氏阳性细菌感染，且报告的耐药率较低，但奎奴普丁-达福普汀的临床应用仍受到限制，这主要是由于其耐受性差。总而言之，链霉素（尤其是保霉素）可以被视为治疗革兰氏阳性感染的潜在替代药物。