TY - JOUR
T1 - Colistin
T2 - New lessons on an old antibiotic
AU - Yahav, D.
AU - Farbman, L.
AU - Leibovici, L.
AU - Paul, M.
N1 - Funding Information:
The limitations of the available data on the clinical efficacy of colistin combinations include low numbers of patients, study design, heterogeneity in the definition of outcomes, variability in the dosing regimens, differences in the susceptibility testing methods, lack of PK information for colistimethate sodium and formed colistin, and the fact that most studies do not stratify outcome by severity of illness [ 97 ]. Several trials assessing colistimethate sodium combination treatment are currently being planned or ongoing. Two RCTs comparing colistimethate sodium with colistimethate sodium plus imipenem for invasive infections caused by carbapenem-resistant Gram-negative bacteria are currently being planned in the USA, Europe, Israel, and Greece, funded by the National Institutes of Health and the EU 7th framework (Keith Kaye and Johan Mouton, personal communication). Two other trials are ongoing in Thailand, comparing colistimethate sodium alone with colistimethate sodium plus fosfomycin [ 108 ] or colistimethate sodium plus rifampicin [ 109 ] for infections caused by MDR A. baumannii .
PY - 2012/1
Y1 - 2012/1
N2 - Colistin has been re-introduced into clinical practice for the treatment of carbapenem-resistant Gram-negative bacteria. Studies in the last decade attempted to reconstruct the path that present-day medications undergo prior to clinical use. In this review, we summarize the results of recent clinical studies. Colistin was associated with lower mortality than no effective treatment and higher unadjusted mortality than β-lactams in non-randomized clinical studies. However, it was administered to sicker patients with carabapenem-resistant bacteria. Overall, nephrotoxicity rates were not higher with colistin in these studies, and colistin-induced nephrotoxicity is reversible in most patients. The emergence of colistin resistance has been described in high-use settings. Synergy with carbapenem, rifampin and other antibiotics has been reported in vitro. Randomized controlled trials are ongoing or in planning to assess this and other aspects of colistin use in clinical practice.
AB - Colistin has been re-introduced into clinical practice for the treatment of carbapenem-resistant Gram-negative bacteria. Studies in the last decade attempted to reconstruct the path that present-day medications undergo prior to clinical use. In this review, we summarize the results of recent clinical studies. Colistin was associated with lower mortality than no effective treatment and higher unadjusted mortality than β-lactams in non-randomized clinical studies. However, it was administered to sicker patients with carabapenem-resistant bacteria. Overall, nephrotoxicity rates were not higher with colistin in these studies, and colistin-induced nephrotoxicity is reversible in most patients. The emergence of colistin resistance has been described in high-use settings. Synergy with carbapenem, rifampin and other antibiotics has been reported in vitro. Randomized controlled trials are ongoing or in planning to assess this and other aspects of colistin use in clinical practice.
KW - Colistin
KW - Multidrug-resistant bacteria
KW - Nephrotoxicity
KW - Polymyxins
KW - Ventilator-associated pneumonia
UR - http://www.scopus.com/inward/record.url?scp=83655164078&partnerID=8YFLogxK
U2 - 10.1111/j.1469-0691.2011.03734.x
DO - 10.1111/j.1469-0691.2011.03734.x
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C2 - 22168320
AN - SCOPUS:83655164078
SN - 1198-743X
VL - 18
SP - 18
EP - 29
JO - Clinical Microbiology and Infection
JF - Clinical Microbiology and Infection
IS - 1
ER -
