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综述:抗菌药物输送到眼表面的新策略:对感染性角膜炎的影响

Sharma, A., Taniguchi, J.

期刊名称:The Ocular Surface

卷期:2017年第15卷第4期

摘要

摘要:感染性角膜炎是一种医疗急症,如果不及时治疗,可引起严重的视力疾病。根据致病微生物,感染性角膜炎的有效治疗需要频繁使用抗细菌,抗真菌或抗病毒滴眼剂,这些药物可能具有低的生物利用度,不希望的副作用和较差的患者依从性。正在研发的可以增加角膜渗透并可延长眼表面存在的抗微生物眼部制剂。这样的制剂包括纳米颗粒,粘膜粘附剂,原位形成水凝胶和隐形眼镜。在体外模型和体外切除的角膜中以及兔体内试验中检测这些制剂已经证实可增加生物利用度,延长角膜上存在。许多这些制剂在动物模型中也可成功治疗感染性角膜炎。然而,大多数研究已经评估了氟喹诺酮类抗菌药物,还需更多的研究来测试抗真菌药物的输送。此外,需要在动物模型和人未来研究中确定这些抗微生物剂在泪液中抑制浓度持续时间的额外数据,以证明这些制剂对感染性角膜炎临床治疗的有效性。

Infectious keratitis is a medical emergency that can cause severe visual morbidity if not treated promptly. Depending upon the causative microorganism, effective management of infectious keratitis requires frequent application of antibacterial, antifungal, or antiviral eye drops, which may have low bioavailability, undesirable side effects, and poor patient compliance. Ocular formulations of antimicrobials that can increase corneal permeation and provide extended presence on ocular surface are being developed. Such formulations include nanoparticles, mucoadhesives, in situ forming hydrogels, and contact lenses. Testing of these formulations in in vitro models and ex vivo excised corneas, and in vivo rabbit testing have demonstrated increased bioavailability and extended presence on the cornea. Many of these formulations have also demonstrated success in treating infectious keratitis in animal models. However, the majority of studies have evaluated fluoroquinolone antibacterials, and more studies are needed to test the delivery of antifungal drugs. Moreover, additional efficacy data in animal models and future studies in humans to determine the duration of inhibitory concentrations of these antimicrobials in tear fluid will be required to prove the effectiveness of these formulations for clinical management of infectious keratitis.


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