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.

Opportunities to optimise colistin stewardship in hospitalised patients in South Africa: Results of a multisite utilisation audit

“…Audit of colistin process measures included the following: obtaining a culture prior to colistin initiation, prescription of a loading dose, prescription of correct loading and maintenance doses, and adjustments of maintenance doses according to renal function as stipulated by two SA guidelines, [10,15] administration of colistin in combination with another antibiotic, duration of therapy (calculated as number of treatment days), and de-escalation following culture and sensitivity results. First or repeat courses were also documented, and the type of culture specimens, the organisms cultured and the sensitivity profiles were matched to the prescription data.…”

Multidrug-resistant Gram-negative Bacterial Infections in Critically Ill

“…46,47 The loading doses do not affect kidney function, but the maintenance doses have to be adjusted depending on the kidney function. 48 Colistin nebulization should be used in addition to intravenous therapy in patients with VAP due to MDR GNB. 49 Colistin combination therapy: colistin with meropenem combination had better outcome than any other combination with colistin.…”

Usage of antibiotics in the intensive care units of an academic tertiary-level hospital

“…Colistin is reserved for patients who have an infection at a usually sterile site that is resistant to other agents. In our study, colistin was used in line with the South African Colistin Guidelines 2016, 16 which includes a loading dose of 12 mu followed by 3 mu eight hourly.…”