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Published on: April 18, 2019
Evaluation of colistin as an agent against multi-resistant Gram-negative bacteria
Jian Li1, Roger L Nation, Robert W Milne
1Facility for Anti-infective Drug Development and Innovation, Victorian College of Pharmacy, Monash University, Parkville, Vic. 3052, Australia. jian.li@vcp.monash.edu.au
Abstract:
Infections caused by multi-resistant Gram-negative bacteria, particularly Pseudomonas aeruginosa, are increasing worldwide. In patients with cystic fibrosis (CF), resistance in P. aeruginosa to numerous anti-pseudomonal agents is becoming common. The absence since 1995, of new substances active against resistant Gram-negative bacteria, has caused increasing concern. Colistin, an old antibiotic also known as polymyxin E, has attracted more interest recently because of its significant activity against multi-resistant P. aeruginosa, Acinetobacter baumannii and Klebsiella pneumoniae, and the low resistance rates to it. Because its use as an anti-pseudomonal agent was displaced by the potentially less toxic aminoglycosides in 1970s, our knowledge of this drug is limited. However, there has been a significant recent increase in the data gathered on colistin, focussing on its chemistry, antibacterial activity, mechanism of action and resistance, pharmacokinetics, pharmacodynamics and new clinical application. It is likely that colistin will be an important antimicrobial option against multi-resistant Gram-negative bacteria, for some years to come.
Insights
Colistin, an old antibiotic, shows significant activity against multi-resistant Gram-negative bacteria like Pseudomonas aeruginosa. Growing resistance necessitates exploring effective treatments, positioning colistin as a key option.
Area of Science:
- Microbiology
- Infectious Diseases
- Pharmacology
Background:
- Increasing global infections caused by multi-resistant Gram-negative bacteria, especially Pseudomonas aeruginosa.
- Rising resistance in Pseudomonas aeruginosa to existing anti-pseudomonal agents in cystic fibrosis (CF) patients.
- Lack of new antimicrobial substances active against resistant Gram-negative bacteria since 1995.
Purpose of the Study:
- To review the recent surge in data on colistin (polymyxin E).
- To highlight colistin's efficacy against multi-drug resistant Gram-negative bacteria.
- To assess colistin's potential as a future antimicrobial option.
Main Methods:
- Literature review of recent studies on colistin.
- Analysis of colistin's chemistry, antibacterial activity, and mechanism of action.
- Examination of colistin's resistance patterns, pharmacokinetics, pharmacodynamics, and clinical applications.
Main Results:
- Colistin demonstrates significant activity against multi-resistant Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae.
- Low rates of resistance to colistin have been observed.
- Recent research has expanded knowledge on colistin's properties and uses.
Conclusions:
- Colistin is a valuable antibiotic with renewed interest due to its effectiveness against challenging Gram-negative infections.
- Despite limited historical data, current research supports colistin's role in combating multi-resistant bacteria.
- Colistin is anticipated to remain an important therapeutic choice for the foreseeable future.
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