Colistin: efficacy and safety in different populations

Abstract

This article reviews mechanisms, incidences, risk factors and preventive modalities of colistin toxicity as well as colistin use in special populations and through special routes. All clinical studies that examined the pharmacokinetic/pharmacodynamic, efficacy and side effects of colistin in the management of multidrug-resistant organisms in different patient population including pediatrics, adults, obese, critically ill, burn or cancer patients with any route of drug administration were considered. Compared with older recommended doses, current dosing approach improves cure rate without significant increase in the rate of colistin-induced nephrotoxicity. Efficacy and safety of high doses of colistin should be considered in the future studies. Also comparing efficacy and safety of different doses of aerosolized colistin and defining the appropriate dose in different populations is another open area of future researches.

Keywords:

• colistimethate
• colistin
• nephrotoxicity
• neurotoxicity

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

Key issues

• Incidence of colistin-induced nephrotoxicity varies from 0 to 54% in different studies.

• In the recent studies, neurotoxicity of colistin has been reported as a rare complication.

• Compared with older administered doses, current dosing approach improves cure rate.

• No data are available regarding safety of prolonged use of high dose (e.g., 9 MIU/day) colistin regimen.

• Although occurrence of colistin-induced AKI is common, magnitude of increase in serum creatinine concentration, need for renal replacement therapy, permanent nephrotoxicity and need for drug discontinuation were low.

• Adding aerosolized colistin to intravenous colistin may improve clinical cure without increasing the rate of nephrotoxicity.

• Colistin has low rate of nephrotoxicity in pediatric and neonate patients.

• Colistin showed comparable pharmacokinetic/pharmacodynamic properties in different patient population.