Colistin in Critically Ill Patients: A Critical Review

Abstract

Colistin emerged in the last decade as a savior for the treatment of critically septic patients who suffer MDR-GNB infections. This development came in time with the drying new antibacterial pipelines. MDR-GNB became problematic in ICU's including MDR Acinetobacter spp., Pseudomonas aeruginosa, and carbapenemase-producing Enterobacteriaecae (CPE). With the resurgence of wide colistin prescription especially in ICU's, awareness on when to switch to this reintroduced drug is required. Recently, it is observed that there are differences between the past dosages and the currently proposed dosages. Nephrotoxicity and neurotoxicity are observed to be less than what was published in the past. This may be due to more pure preparations and attention to other drug therapies that are employed in the critically ill patients residing the ICU's. However,randomized control studies are still lacking to shed light on its efficacy and safety. Agreement is still looming on dosages, and monotherapy of colistin versus its combination with other agents.

Bacteraemia in Intensive Care Unit: Clinical, Bacteriological, and Prognostic Prospective Study

“…Colistin emerged in the last decade as a savior for the treatment of critically septic patients who suffer MDR-GNB infections [24]. It is frequently used as combination therapy in order to maximize killing effect of pathogens, reducing rate of resistance, optimizing clinical outcome, and reducing mortality [25].…”

“…It is frequently used as combination therapy in order to maximize killing effect of pathogens, reducing rate of resistance, optimizing clinical outcome, and reducing mortality [25]. However two earlier meta-analyses published in 2003 and 2004 in BMJ revealed that combination therapy did not change rates of fatality and increased adverse events [24]. …”

COLISTIN: adult and paediatric guideline for South Africa, 2016

“…2 A large retrospective cohort study from 2000 to 2007 showed incidence rates as low as 10%. 11 The reason for the lower rates of nephrotoxicity may be due to the use of more purified preparations, better ICU monitoring and avoidance of the coadministration of other nephrotoxic drugs (e.g. the aminoglycosides and vancomycin).…”