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Colistin Use in Patients With Reduced Kidney Function.

Enrico Fiaccadori1, Elio Antonucci2, Santo Morabito3

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American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
|May 11, 2016
PubMed
Summary

Colistin, a last-resort antibiotic for resistant infections, requires careful dosing in kidney disease. Dosing adjustments are crucial for patients on renal replacement therapy to avoid toxicity and ensure efficacy.

Keywords:
Acute kidney injury (AKI)chronic kidney disease (CKD)colistimethatecolistincolistin methanesulfonatecolistin pharmacokineticscontinuous renal replacement therapies (CRRTs)critical illnessdialysishemofiltrationkidney functionnephrotoxicitypolymyxin Erenal toxicitytherapeutic drug monitors

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Area of Science:

  • Pharmacology
  • Nephrology
  • Infectious Diseases

Background:

  • Colistin (polymyxin E) is a critical antibiotic for multidrug-resistant Gram-negative bacteria.
  • Its use was limited by neurotoxicity and nephrotoxicity but has been revived as a last-resort treatment.
  • Limited data exist on colistin pharmacokinetics and pharmacodynamics in patients with kidney disease.

Purpose of the Study:

  • To review colistin's chemical structure, pharmacodynamics, pharmacokinetics, and renal toxicity.
  • To discuss current data and recommendations for colistin dosing in patients with impaired kidney function, particularly those undergoing renal replacement therapy (RRT).

Main Methods:

  • Literature review focusing on colistin's properties and clinical use in renal impairment.
  • Analysis of studies concerning colistin dosing strategies in patients with acute or chronic kidney disease.
  • Examination of recommendations for colistin administration during dialysis and hemofiltration.

Main Results:

  • Colistin exhibits concentration-dependent bactericidal activity.
  • Renal toxicity is a significant dose-related adverse effect.
  • Colistin can be removed by RRT, necessitating higher dosing regimens and therapeutic drug monitoring.

Conclusions:

  • Optimizing colistin dosing in patients with kidney disease, especially those on RRT, is essential to balance efficacy and toxicity.
  • Current recommendations suggest higher colistin doses for patients undergoing RRT.
  • Therapeutic drug monitoring is advised for colistin therapy in patients with reduced kidney function.