The use of colistin for infections caused by multidrug-resistant Gram-negative microorganisms
The use of colistin (polymyxin E) for the treatment of infections caused by multi-drug resistant Gram negative microorganisms (P.aeruginosa and A.baumannii) is effective and safe.
Colistin (polymyxin E) - a drug discovered more than 60 years ago, has rarely been used since the early 1980s. Of the last century due to its nephrotoxicity, with the exception of the treatment of patients with cystic fibrosis. Colistin is a cyclic polypeptide whose mechanism of action is the bactericidal effect on the cell membrane of a number of gram-negative bacteria (Escherichia coli, Klebsiella spp., Enterobacter spp., Salmonella spp., Shigella spp., Haemophilus influenzae, Brucella spp., Pseudomonas aeruginosa, Acinetobacter spp.), including strains resistant to other antibacterial drugs. Pharmacological activity may be associated with low levels of colistin resistance. With intravenous or intramuscular administration, the drug is distributed to many tissues of the body, passes poorly through the BBB. Excreted mainly by the kidneys.
The purpose of the study by Spanish scientists was to study the efficacy and safety (the appearance of nephrotoxicity) when using colistin for the treatment of infections caused by microorganisms Multi-resistant gram negatives.
This study included adult hospital patients who were treated with an inhaled, injectable or intrathecal form of colistin.
80 patients received colistin for the period January to October 2001, including 69 (86%) patients infected with A.baumannii and 11 patients (14%) with P.aeruginosa . During the study period, patients received 71 inhalants, 12 injections and 2 intrathecal cycles of colistin.
Previous antibiotic therapy (antibiotic treatment for at least 48 hours up to 10 days before bacteriological studies) was as follows: carbapenems (imipenem, meropenem) - 17 patients (21%), amoxicillin / clavulanate - 15 patients (18%) , piperacillin / tazobactam - 12 patients (15%), ciprofloxacin - 9 patients (11%), third generation aminoglycosides + cephalosporin - 5 patients (8%), ceftazidime or cefepime - 2 patients (3%), aminoglycoside - 1 patient (1%), tobramycin (inhalation) - 2 patients (3%), aztreonam - 1 patient (1%)
Concomitant antibiotic therapy (with colistin) included: carbapenem - 28 patients (35%), piperacillin / tazobactam - 12 patients (15%), ciprofloxacin - 8 patients (10%), carbapenem + aminoglycoside - 5 patients (7%) , amoxicillin / clavulanate - 3 patients (4%), tobramycin (inhalation) - 2 patients (3%), ceftazidime - 1 patient (1%), 3rd generation cephalosporin + aminoglycoside - 1 patient (1%).
In 41 patients (51%), the infection was caused by strains A.baumannii which were only sensitive to colistin. In 92% of patients who underwent repeated bacteriological studies after treatment, no causative agent was isolated. In patients receiving parenteral colistin, there was no significant increase in serum urea and creatinine levels from baseline.
Thus, treatment with colistin of infections caused by multidrug-resistant Gram negative microorganisms (P.aeruginosa and A.baumannii) is effective and safe.