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Dosing of colistin-back to basic PK/PD

Phillip J Bergen1, Jian Li, Roger L Nation

  • 1Drug Delivery, Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, Melbourne, Australia.

Current Opinion in Pharmacology
|August 13, 2011
PubMed

Insights

Colistin methanesulfonate (CMS) is crucial for treating multidrug-resistant Gram-negative infections. Current CMS dosage guidelines are suboptimal, leading to treatment failures and resistance, especially in critically ill patients.

Area of Science:

  • Pharmacology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Rising multidrug-resistant Gram-negative bacteria necessitates re-evaluating colistin.
  • Colistin methanesulfonate (CMS) is a vital salvage therapy for difficult infections.
  • Current CMS dosage guidelines lack scientific basis, leading to adverse outcomes.

Purpose of the Study:

  • To review recent advancements in understanding CMS and colistin pharmacokinetics and pharmacodynamics.
  • To emphasize the implications for critically ill patients.
  • To inform the design of optimal colistin dosage regimens.

Main Methods:

  • Review of recent pharmacokinetic and pharmacodynamic data for CMS and colistin.
  • Focus on critically ill patient populations.
  • Analysis of the PK/PD relationship to guide dosing.

Main Results:

  • Current CMS dosage regimens are frequently suboptimal in critically ill patients.
  • Emerging data highlight the need for evidence-based dosing strategies.
  • Understanding PK/PD is key to improving colistin efficacy.

Conclusions:

  • Optimizing colistin methanesulfonate (CMS) dosing is critical for effective treatment of multidrug-resistant Gram-negative infections.
  • Evidence-based pharmacokinetics and pharmacodynamics are essential for improving patient outcomes.
  • Revised dosing strategies are needed to combat treatment failure and resistance.

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