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Colistin for lung infection: an update
1Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, UP India.
Journal of Intensive Care
|February 24, 2015
Summary
Colistin is an old antibiotic used for multidrug-resistant infections. New evidence suggests higher doses and inhaled administration may improve efficacy and reduce toxicity for gram-negative bacterial infections.
Area of Science:
- Pharmacology
- Infectious Diseases
- Microbiology
Background:
- Rising resistance to newer antibiotics, including carbapenems, necessitates exploring older drugs like colistin for multidrug-resistant (MDR) infections.
- Colistin exhibits potent bactericidal activity against gram-negative bacilli but has limited distribution to certain tissues like lungs and cerebrospinal fluid.
- Lack of comprehensive pharmacokinetic (PK) and pharmacodynamic (PD) data for colistin, due to its history as an older drug, hinders understanding of its efficacy predictors.
Purpose of the Study:
- To evaluate the PK/PD parameters of colistin in treating MDR gram-negative bacterial infections.
- To investigate the efficacy of different colistin dosing strategies, including high loading and maintenance doses.
- To assess the potential of inhaled colistin for treating lung infections and its comparative toxicity.
Main Methods:
- Review of available PK/PD studies on colistin.
- Analysis of colistin serum and tissue concentrations at various dosages.
- Examination of combination therapy efficacy, particularly with carbapenems.
- Assessment of recent studies on inhaled colistin for lung infections.
Main Results:
- Mean maximum serum concentrations (Cmax) of colistin are often suboptimal, even at standard high doses (3.0 MIU IV q8h).
- Poor lung tissue penetration of intravenous colistin is a significant concern for treating respiratory infections.
- Combination therapy, especially with carbapenems, demonstrates synergistic effects.
- Inhaled colistin shows promise for lung infections with potentially reduced toxicity compared to previous reports.
Conclusions:
- Higher loading and maintenance doses of intravenous colistin may be necessary to achieve therapeutic concentrations.
- Inhaled colistin presents a promising alternative for treating gram-negative lung infections, potentially offering better efficacy and safety.
- Further research into colistin's PK/PD is crucial for optimizing treatment strategies against MDR gram-negative bacteria.
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