COLISTIN: adult and paediatric guideline for South Africa, 2016

Abstract

This document was created to serve as a guideline for colistin prescribing in South Africa. Antimicrobial resistance is threatening the effective prevention and treatment of a wide variety of infections, especially those that are caused by multi-drug-resistant (MDR) gram-negative bacteria. Colistin is typically used as salvage therapy, or last-line treatment, for MDR gram-negative infections. The dosing regimen should be optimised to be therapeutic and halt the emergence of resistance, whilst minimizing toxicity. This document provides evidence-based recommendations for adult and paediatric dosing, dosing in renal impairment, and the use of combination therapy to increase synergistic effects, as well as guidelines on the reconstitution and administration of colistin. This guideline is specifically aimed at healthcare workers who routinely treat patients with MDR gram-negative infections, especially in the intensive care setting.

Ongoing strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries: findings and implications for the future

“…As a result, bacteria causing severe health problems have become resistant to multiple antibiotics during the past 20-30 years 18,37,38 . This overuse urgently needs addressing alongside the development and implementation of guidelines to restrict the use of key antibiotics as well as reduce their inappropriate use [39][40][41] .…”

A retrospective review of colistin utilisation at a tertiary care academic hospital in South Africa

“…5 In South Africa (SA), colistin is used as salvage therapy for life-threatening infections, 1,2 especially where resistance to the carbapenem class of antibiotics has been observed. 6 The carbapenems have been considered to be part of the last line of defence against MDR gram-negative bacterial infections. 7 Therefore, the increase in microbial resistance to carbapenems and other antibiotic classes has led to the increased use of colistin in SA.…”

“…Colistin, a polymyxin antibiotic, displays activity against MDR Acinetobacter and Pseudomonas as well as Enterobacter aerogenes, Escherichia coli (E. coli) and Klebsiella species. 6 Colistin was discovered in the 1940s; however, reports of nephrotoxicity led to the decline in its use in the 1970s. 6,8 High incidences of reported toxicities were as a result of inappropriate dosing regimens and are much more uncommon than previously thought.…”

“…6 Colistin was discovered in the 1940s; however, reports of nephrotoxicity led to the decline in its use in the 1970s. 6,8 High incidences of reported toxicities were as a result of inappropriate dosing regimens and are much more uncommon than previously thought. 9 Adverse effects, such as nephrotoxicity and neurotoxicity, are largely considered to be dose dependent and reversible.…”

Intravenous colistin in the treatment of multidrug-resistant gram-negative organism in tertiary hospital, Jazan, KSA

“…Therefore, nephrotoxicity was found to be intramuscular administrated as reported by previous literature. [ 5 6 ] Patients who had chronic renal disease showed 36% incidence of nephrotoxicity,[ 5 7 ] while by the time the rate of nephrotoxicity incidence decreased to be 10% that might attribute to more than reason; good monitoring of the intensive care unit (ICU), or purified preparation of the colistin, or avoid interference with any drugs that leading to nephrotoxic such as vancomycin and NSAIDs as reported in previous study from 2000 to 2007. [ 4 ] Although there are other risk factors that led to nephrotoxicity such as decreasing of albumin level, using of anti-inflammatory drug, elder age, and lack efficiency of kidney.…”