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Updated: Aug 6, 2026
Antibiotic Efficacy Testing in an Ex vivo Model of Pseudomonas aeruginosa and Staphylococcus aureus Biofilms in the Cystic Fibrosis Lung
Published on: January 22, 2021
Parenteral and inhaled colistin for treatment of ventilator-associated pneumonia
Peter K Linden1, David L Paterson
11Abdominal Organ Transplant Intensive Care Unit, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15261, USA. lindenpk@ccm.upmc.edu
Abstract:
The spectrum of available therapeutic options has become drastically narrowed in recent years, particularly for nosocomial multidrug-resistant gram-negative pathogens. This therapeutic void has created a resurgence of interest in colistin. In 5 published series since 1999, clinical response rates for pneumonia due to Pseudomonas aeruginosa or Acinetobacter baumannii treated with intravenous colistin have ranged from 25% to 62%, despite high severity of illness at baseline. De novo nephrotoxicity was observed in 8%-36% of patients, despite close attention to both appropriate dosing and duration of treatment. Neurotoxicity, which was commonly described in the old colistin era, has been exceedingly rare in recent experience. Aerosolized therapy as an adjunct to systemic treatment appears promising, but the current published data are much too limited to allow determination of the incremental benefit of the addition of aerosolized treatment to systemic treatment. Colistin is a reasonably safe last-line therapeutic alternative for pneumonia due to multi- or panresistant P. aeruginosa or A. baumannii.
Insights
Colistin is a vital last-line antibiotic for treating severe pneumonia caused by multidrug-resistant gram-negative pathogens like Pseudomonas aeruginosa and Acinetobacter baumannii. While effective, it carries risks of nephrotoxicity and rare neurotoxicity.
Area of Science:
- Infectious Diseases
- Pharmacology
- Critical Care Medicine
Background:
- Limited therapeutic options for nosocomial multidrug-resistant gram-negative pathogens.
- Resurgence of interest in colistin due to the therapeutic void.
- Colistin as a last-line agent for challenging infections.
Purpose of the Study:
- To evaluate the clinical efficacy and safety of colistin for pneumonia.
- To assess the incidence of nephrotoxicity and neurotoxicity associated with colistin treatment.
- To explore the potential of aerosolized colistin as an adjunct therapy.
Main Methods:
- Review of 5 published series since 1999 involving patients with pneumonia treated with intravenous colistin.
- Analysis of clinical response rates and adverse events, including de novo nephrotoxicity and neurotoxicity.
- Assessment of limited data on aerosolized colistin as an adjunct to systemic treatment.
Main Results:
- Clinical response rates for pneumonia due to Pseudomonas aeruginosa or Acinetobacter baumannii ranged from 25% to 62%.
- De novo nephrotoxicity was observed in 8%-36% of patients, despite careful dosing and duration.
- Neurotoxicity was rare in recent experience, contrasting with historical data.
Conclusions:
- Colistin is a reasonably safe last-line therapeutic option for pneumonia caused by multi- or panresistant P. aeruginosa or A. baumannii.
- Aerosolized colistin as an adjunct shows promise but requires more extensive data.
- Careful monitoring for nephrotoxicity is crucial in patients receiving colistin therapy.
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