Colistin past and future: a bibliographic analysis.

Area of Science:

• Pharmacology and Infectious Diseases
• Drug Development and Public Health

Background:

• Colistin, an older antibiotic, is experiencing a resurgence due to rising multidrug resistance (MDR) and a scarcity of effective treatments.
• Understanding publication trends related to colistin, MDR infections, and adverse events offers insights into the medical-academic community's engagement and informs redevelopment strategies.

Purpose of the Study:

• To synthesize publication trends concerning multidrug resistance (MDR) infections, colistin usage, and its associated adverse events over a 50-year period.
• To analyze historical publication patterns to inform and guide current colistin redevelopment strategies and antibiotic discovery efforts.

Main Methods:

• A comprehensive multidatabase electronic literature search was conducted, spanning 50 years, utilizing Web of Knowledge with back- and forward-referencing.
• Publications were categorized into three main themes: multidrug resistance (MDR), colistin, and adverse events.
• The identified studies were grouped into 5-year clusters to map distinct publication trends over time.

Main Results:

• Three distinct publication periods were identified: 1940-1975 (increasing publications, followed by adverse-event focus), 1975-2000 (sharp decline in publications), and post-2000 (sharp increase mirroring MDR literature growth).
• The period of publication decline (1975-2000) predated modern standardized pharmacologic requirements.
• The recent surge in publications (post-2000) coincided with advancements in novel drug development techniques and a rise in MDR literature.

Conclusions:

• Current colistin research follows two main trends: optimizing existing formulations (informed by past research) and developing novel, patentable colistin derivatives through chemical reengineering.
• Research efforts include pharmacokinetic/pharmacodynamic analysis, purification, formulation improvements, and resistance surveillance for current colistin optimization.
• The analysis of colistin's historical publication trends provides a case study to potentially stimulate strategies for replenishing the diminishing antibiotic pipeline.