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Updated: Oct 12, 2025

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
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Opportunities to enhance antibiotic stewardship: colistin use and outcomes in a low-resource setting

Muhammad S Moolla1,2, Andrew Whitelaw3,4, Eric H Decloedt5

  • 1Division of General Medicine, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.

Jac-Antimicrobial Resistance
|November 22, 2021
PubMed
Abstract

Insights

Colistin stewardship errors are common, affecting 77% of patients, particularly in renal function monitoring. This highlights the urgent need for improved colistin use to combat rising resistance.

Area of Science:

  • Infectious Diseases
  • Pharmacology
  • Clinical Pharmacy

Background:

  • Colistin use is rising globally due to multidrug-resistant Gram-negative infections.
  • Effective antibiotic stewardship is crucial for preserving colistin as a last-resort antibiotic.

Purpose of the Study:

  • To investigate stewardship and safety errors in colistin prescribing.
  • To identify areas for improvement in colistin utilization.

Main Methods:

  • Prospective descriptive study of patients aged 13+ treated with colistin.
  • Data collected on clinical, laboratory, and outcome parameters.
  • Assessment of colistin treatment for stewardship and safety errors.

Main Results:

  • Treatment errors occurred in 77% of 44 patients, most frequently inadequate renal function monitoring (32%).
  • Other errors included lack of rational indication (20%), incorrect loading/maintenance doses (27%/23%), and failure to de-escalate or adjust for renal function.
  • In-hospital mortality was 47%, with 18% experiencing renal injury. Colistin-resistant organisms were found in 7% of patients.

Conclusions:

  • Significant opportunities exist to enhance colistin stewardship and improve prescription safety and efficacy.
  • The emergence of colistin resistance underscores the critical need for appropriate and effective colistin use.

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