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Colistin administration to pediatric and neonatal patients
Elias Iosifidis1, Charalampos Antachopoulos, Maria Ioannidou
13rd Department of Pediatrics, Aristotle University School of Medicine, Hippokration Hospital, Konstantinoupoleos 49, GR 54642, Thessaloniki, Greece.
Insights
Colistin is increasingly used for multidrug-resistant Gram-negative infections. This case series shows intravenous colistin is safe and effective in pediatric patients, even at higher doses and for prolonged durations.
Area of Science:
- Infectious Diseases
- Pediatric Pharmacology
- Antimicrobial Resistance
Background:
- The rise of multidrug-resistant Gram-negative pathogens necessitates the re-evaluation of older antibiotics like colistin.
- Limited data exists on the safety and efficacy of colistin in pediatric populations, with undefined optimal dosing.
Purpose of the Study:
- To evaluate the safety and efficacy of intravenous colistin in neonates and children without cystic fibrosis.
- To explore various dosing regimens and treatment durations for colistin in pediatric patients.
Main Methods:
- A retrospective case series of pediatric patients treated with intravenous colistin between January 2007 and March 2009.
- Review of patient records to analyze administered colistin doses (colistimethate), treatment duration, co-administered antimicrobials, and clinical outcomes.
Main Results:
- Thirteen pediatric patients received 19 courses of colistin for serious infections caused by Gram-negative bacteria.
- Colistin doses ranged from 40,000 to 225,000 IU/kg/day for 1 to 133 days.
- Sixteen of 19 treatment courses resulted in a favorable outcome, with one instance of increased serum creatinine potentially linked to combination therapy.
Conclusions:
- Intravenous colistin administration appears well-tolerated in pediatric patients, including neonates.
- Higher doses and prolonged durations of colistin may be safe and effective for treating serious Gram-negative infections in children.
- Further research is warranted to establish optimal dosing guidelines for pediatric use.
Abstract:
Emergence of multidrug-resistant Gram-negative nosocomial pathogens has led to resurgence of colistin use. Safety and efficacy data regarding colistin use in pediatric patients are sparse, while optimal dosage has not been defined. We present a case series of neonates and children without cystic fibrosis treated with various doses of colistin intravenously. The records of patients who received colistin in a tertiary-care hospital from January 2007 to March 2009 were reviewed. Thirteen patients (median age 5 years, range 22 days to 14 years) received 19 courses of colistin as treatment of pneumonia, central nervous system infection, bacteremia, or complicated soft tissue infection. The isolated pathogens were Acinetobacter baumannii, Enterobacter cloacae, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia. Daily dose of colistin (colistimethate) ranged between 40,000 and 225,000 IU/kg. Duration of administration ranged from 1 to 133 days. Other antimicrobials were co-administered in 18/19 courses. Increase of serum creatinine in one patient was associated with co-administration of colistin and gentamicin. Sixteen of 19 courses had a favorable outcome, and only two of the three deaths were infection-related. Colistin intravenous administration appears well tolerated even at higher than previously recommended doses and of prolonged duration.
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