[Colistin in the post-antibiotic era]

Area of Science:

• Microbiology
• Infectious Diseases
• Pharmacology

Background:

• Colistin resurgence in the post-antibiotic era for extensively drug-resistant (XDR) gram-negative bacteria.
• Effective against key pathogens like Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae.
• Improved safety and management have reduced toxicity, but confusion persists regarding dosing and nomenclature.

Purpose of the Study:

• To address confusion surrounding colistin's dosage, name, and labeling.
• To highlight the need for standardized language for this polymyxin antibiotic.
• To underscore the lack of pharmacokinetic/pharmacodynamic (PK/PD) studies and evaluate combination therapy efficacy.

Main Methods:

• Review of current literature on colistin use in XDR gram-negative infections.
• Analysis of expert recommendations for colistin nomenclature and dosing.
• Examination of evidence regarding colistin's efficacy, particularly in combination therapy.

Main Results:

• Colistin remains vital for treating XDR gram-negative infections.
• Standardized language and clear dosing guidelines are recommended due to persistent confusion.
• Pharmacokinetic/pharmacodynamic (PK/PD) data for colistin are notably lacking.
• The efficacy of colistin in combination with other agents in reducing mortality has not been demonstrated.

Conclusions:

• Colistin is a critical antibiotic for XDR gram-negative bacterial infections.
• Standardization of colistin's name, labeling, and dosing is essential.
• Further PK/PD research is needed, and the benefit of colistin combination therapy requires more evidence.