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Optimizing colistin dosing: Is a loading dose necessary?

Lama H Nazer1, Nadine Anabtawi2

  • 1Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan. lnazer@khcc.jo.

American Journal of Health-System Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists
|December 24, 2016
PubMed
Summary
This summary is machine-generated.

Administering a colistin loading dose may be necessary for severe infections caused by multidrug-resistant gram-negative bacteria. This review of limited data suggests loading doses can help achieve effective colistin concentrations faster.

Keywords:
colistinloading dosepharmacokineticsreviewtreatment outcome

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Area of Science:

  • Pharmacology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Colistin is crucial for treating multidrug-resistant gram-negative bacterial infections.
  • Achieving therapeutic colistin concentrations can be slow without a loading dose due to prodrug conversion and long half-life.
  • Limited data exist on the clinical utility of colistin loading doses.

Purpose of the Study:

  • To review published literature on the pharmacokinetics and effectiveness of colistin loading doses.
  • To evaluate the necessity and impact of colistin loading doses in treating multidrug-resistant infections.

Main Methods:

  • Systematic literature search for studies on colistin loading doses.
  • Review of pharmacokinetic data regarding colistin and colistimethate sodium conversion.
  • Analysis of clinical effectiveness data from available studies, including comparisons with standard dosing.

Main Results:

  • Pharmacokinetic data show loading doses accelerate achievement of adequate colistin concentrations.
  • Clinical effectiveness studies reported high cure rates (73-82%) in some cases.
  • Comparative studies showed mixed results, with one study indicating higher cure rates with loading doses (63% vs. 41.3%, p=0.04), while another found no significant difference.

Conclusions:

  • Published data on colistin loading dose effectiveness are limited.
  • A colistin loading dose may be beneficial in severe and life-threatening infections caused by multidrug-resistant gram-negative bacteria.
  • Further research with larger sample sizes and standardized protocols is warranted.