Attention to Colistin Dose: A Case Report of Rare Neurotoxic Adverse Effects

Abstract

olymyxin antibiotics are necessarily preferable in the treatment of problematic bacteria such as multi-drug resistance Acinetobacter baumannii, Pseudomonas aeruginosa and carbapenemase-producing enteric microorganism.1 In practice, only polymyxin E (colistin) and polymyxin B are used. There are two major adverse effects related to colistin therapy. Nephrotoxicity is one of the generally observed adverse effects following intravenous treatment of colistin. Neurotoxicity is a less common adverse effect than nephrotoxicity. Neurotoxic side effects are generally mild and reversible after stopping the treatment. The ideal dose for colistin remains uncertain. Colistin loading dose is calculated independently of creatinine clearance (CCr). Our purpose is to discuss this entity. A AB BS ST TR RA AC CT T Colistin is a polymyxin antibiotic that is used for the treatment of multidrug-resistant Gram-negative bacteria. The most important side effects of intravenous colistin is nephrotoxicity and neurotoxicity. Neurotoxicity is seen much less frequently (<%7) than nephrotoxicity. Because of the ideal dose for colistin remains uncertain and loading dose is calculated independently of creatinine clearance in patients with kidney disease its safety is unclear. In this paper we present a case of colistin neurotoxicity in a patient with complaints of weakness, dizziness, visual disturbances, ataxia and peripheral paresthesia 5-6 hours after loading dose who has kidney disease. Colistin treatment was stopped, ascorbic acid was added to the treatment and 2-3 hours after hemodialysis, his neurotoxicity symptoms disappeared.K Ke ey yw wo or rd ds s: : Adverse effects; colistin; polymyxins Ö ÖZ ZE ET T Kolistin, çoklu ilaç dirençli Gram-negatif bakterilerin tedavisinde kullanılan bir polimiksin antibiyotiktir. İntravenöz kolistinin en önemli yan etkileri nefrotoksisite ve nörotoksisitedir. Nö-rotoksisite, nefrotoksisiteye göre daha az (<%7) görülür. Kolistin için ideal doz belirsiz olduğundan ve yükleme dozu böbrek hastalığı olan hastalarda kreatinin klirensinden bağımsız olarak hesaplandığından, güvenliği açık değildir. Bu yazıda böbrek hastalığı olan bir hastaya yükleme dozundan 5-6 saat sonra ortaya çıkan zayıflık, baş dönmesi, görme bozuklukları, ataksi ve periferik paresteziye ilişkin bir kolistin nörotoksik şikayeti sunulmuştur. Hastanın kolistini kesilmiş, tedaviye askorbik asit eklenmiş ve hemodiyalize alınan hastanın 2-3 saat sonra nörotoksisite semptomları kaybolmuştur.A An na ah ht ta ar r K Ke el li im me el le er r: : İstenmeyen etkiler; kolistin; polimiksinler Nilay Şengül SAMANCI,