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Colistin: Lights and Shadows of an Older Antibiotic
Erica Diani1, Gabriele Bianco2, Milo Gatti3
1Department of Diagnostic and Public Health, Microbiology Section, University of Verona, Strada Le Grazie 8, 37134 Verona, Italy.
Abstract:
The emergence of antimicrobial resistance represents a serious threat to public health and for infections due to multidrug-resistant (MDR) microorganisms, representing one of the most important causes of death worldwide. The renewal of old antimicrobials, such as colistin, has been proposed as a valuable therapeutic alternative to the emergence of the MDR microorganisms. Although colistin is well known to present several adverse toxic effects, its usage in clinical practice has been reconsidered due to its broad spectrum of activity against Gram-negative (GN) bacteria and its important role of "last resort" agent against MDR-GN. Despite the revolutionary perspective of treatment with this old antimicrobial molecule, many questions remain open regarding the emergence of novel phenotypic traits of resistance and the optimal usage of the colistin in clinical practice. In last years, several forward steps have been made in the understanding of the resistance determinants, clinical usage, and pharmacological dosage of this molecule; however, different points regarding the role of colistin in clinical practice and the optimal pharmacokinetic/pharmacodynamic targets are not yet well defined. In this review, we summarize the mode of action, the emerging resistance determinants, and its optimal administration in the treatment of infections that are difficult to treat due to MDR Gram-negative bacteria.
Insights
Colistin, an old antibiotic, is being reconsidered for treating multidrug-resistant Gram-negative infections. Research is clarifying its use, resistance, and optimal dosing for this last-resort drug.
Area of Science:
- Microbiology
- Infectious Diseases
- Pharmacology
Background:
- Antimicrobial resistance (AMR) is a global health crisis, with multidrug-resistant (MDR) infections causing significant mortality.
- Colistin, an older antibiotic, is regaining importance as a last-resort treatment against MDR Gram-negative bacteria.
- Despite its toxicity, colistin's broad-spectrum activity makes it crucial for treating challenging infections.
Purpose of the Study:
- To review the mode of action of colistin.
- To summarize emerging resistance determinants to colistin.
- To discuss the optimal administration and clinical use of colistin for MDR Gram-negative infections.
Main Methods:
- Literature review of colistin's mechanism of action.
- Analysis of studies on colistin resistance mechanisms.
- Synthesis of data on clinical usage and pharmacokinetic/pharmacodynamic targets.
Main Results:
- Colistin functions by disrupting the bacterial cell membrane.
- Emerging resistance mechanisms are being identified, posing challenges to its efficacy.
- Optimal dosing and clinical application strategies are still under investigation.
Conclusions:
- Colistin remains a vital last-resort antibiotic for MDR Gram-negative infections.
- Further research is needed to fully understand and manage colistin resistance.
- Defining optimal pharmacokinetic/pharmacodynamic targets is crucial for effective colistin therapy.
