Спирамицин: прошлое и будущее антибиотика с плейотропными эффектами в терапии внебольничных инфекций

Цель. Поиск и анализ работ, посвященных фармакокинетическим (ФК) и фармакодинамическим (ФД) параметрам спирамицина, позволяющим оценить потенциал данного макролида в терапии внебольничных инфекций.

Материалы и методы. Для поиска материалов были использованы реферативные базы данных: PubMed, Google  Scholar, EMBASE, научно-информационная сеть ResearchGate и elibrary.ru. В работе использовали следующие ключевые запросы: «фармакокинетика спирамицина», «фармакокинетические параметры спирамицина», «pharmacokinetics of spiramycin», «pharmacokinetic parameters of spiramycin», «фармакодинамика, спирамицина», «механизм действия спирамицина», «мишени для спирамицина», «фармакодинамические эффекты спирамицина», «pharmacodynamics of spiramycin», «mechanism of action of spiramycin», «targets for spiramycin», «pharmacodynamic effects of spiramycin». Глубина поиска – 69 лет (1955–2024 гг.), общее число публикаций, включённых в литературный обзор по направлениям «фармакокинетика» и «фармакодинамика» – 72. Общее число использованных в статье источников составило 152.

Результаты. В условиях распространения феномена антибиотикорезистентности (АБР) среди возбудителей как нозокомиальных, так и внебольничных инфекций, актуальным для врача является поиск стратегий, позволяющих сохранить возможность использования антибактериальных препаратов (АБП) первой линии в ведении пациентов с инфекционными заболеваниями. Спирамицин в последние десятилетия характеризовался минимальным уровнем потребления среди населения, в связи с чем имеет потенциал для терапии инфекционных заболеваний. Анализ ФК параметров спирамицина свидетельствует о способности формировать эффективные концентрации в различных тканях и органах, а также о минимальном риске лекарственных взаимодействий, способных изменять  терапевтический ответ. Оценка его антибактериальной активности in vitro и in vivo даёт различные результаты, свидетельствующие о способности препарата проявлять значительно большую эффективность в условиях живого организма. В основе этого парадокса могут лежать плейотропные эффекты спирамицина, вовлекающие как клетки организма хозяина (иммуномодулирующее и противовоспалительное действие, способность благотворно воздействовать на процессы регенерации тканей, противоопухолевая активность, угнетение адипогенеза), так и мишени возбудителей (способность снижать вирулентность Р. aerugenosa, противовирусное действие, снижение способности кокков к адгезии).

Заключение. ФК и ФД параметры и свойства спирамицина наряду с результатами опубликованных клинических исследований, оценивавших его эффективность, указывают на то, что, несмотря на меньшую активность in vitro, наличие дополнительных плейотропных эффектов может быть залогом его превосходства над традиционными макролидами в методах in vivo.

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