Colistin-mediated neurotoxicity

Wadia, Subeer; Tran, Betty T.

doi:10.1136/bcr-2014-205332

Cited by 12 publications

(6 citation statements)

References 5 publications

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“…15,16 Nevertheless, all 3 treatment options have raised strong objections related to both toxicity, drug safety, and clinical efficacy. [15][16][17] CP-Kp isolates are not always highly resistant to carbapenems, and they often exhibit MICs 16 mg/L. 4,18 For these isolates, carbapenems are likely to maintain their clinical efficacy.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Short Versus Prolonged Infusion of Standard Dose of Meropenem Against Carbapenemase-Producing Klebsiella pneumoniae Isolates in Different Patient Groups: A Pharmacokinetic–Pharmacodynamic Approach

Vourli

Tsala

Kotsakis

et al. 2016

Journal of Pharmaceutical Sciences

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Dose optimization is required to increase carbapenem's efficacy against carbapenemase-producing isolates. Four clinical Klebsiella pneumoniae isolates were used: one susceptible to meropenem with minimum inhibitory concentration (MIC) 0.031 mg/L and 3 verona integron-borne metallo bete-lactamase-1-producing isolates with MICs 8, 16, and 128 mg/L. The human pharmacokinetics of short (0.5-h) and prolonged (3-h) infusion regimens of 1 g meropenem every 8 h were simulated in an in vitro pharmacokinetic-pharmacodynamic model. Time-kill curves were constructed for each isolate and dosing regimen, and the %T > MIC associated with maximal bactericidal activity was estimated. The percentage of pharmacodynamic target attainment for isolates with different MICs was calculated for 350 ICU, surgical, and internal medicine patients. The isolates with MIC ≤8 mg/L were killed with both dosing regimens. The %T > MIC corresponding to maximal bactericidal activity was ∼40%. The percentages of target attainment were >90%, 61%-83%, 23%-33%, and <3% with the short infusion regimen and >90%, 98%-99%, 55%-79%, and <5% with the prolonged infusion regimen for isolates with MIC ≤2, 4, 8, and ≥16 mg/L, respectively. The lowest target attainment rates were observed for the ICU patients and the highest for internal medicine patients. The prolonged infusion regimen was more effective than the short infusion regimen against isolates with MIC 4-8 mg/L.

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Section: Discussionmentioning

confidence: 99%

Comparison of Short Versus Prolonged Infusion of Standard Dose of Meropenem Against Carbapenemase-Producing Klebsiella pneumoniae Isolates in Different Patient Groups: A Pharmacokinetic–Pharmacodynamic Approach

Vourli

Tsala

Kotsakis

et al. 2016

Journal of Pharmaceutical Sciences

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“…1,9 After the resurgence in the use of CMS and PMB for multidrug-resistant gram-negative bacteria in this century, there have been several case reports of PMB-or CMS-related respiratory apnea that required intubation. [11][12][13][14][15][16][17] Seven of 9 cases were associated with CMS (Table 2). Our patient received intravenous CMS 3 mg/kg/day divided into 2 doses for 6 weeks.…”

Section: Discussionmentioning

confidence: 99%

Respiratory Muscle Paralysis Associated With Colistin, Polymyxin B, and Muscle Relaxants Drugs

Myint

Evans

Burgess

et al. 2016

Journal of Investigative Medicine High Impact Case Reports

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Polymyxins B and E (colistin) exert a bactericidal effect on the gram-negative bacterial cell wall, causing permeability changes in the cytoplasmic membrane, leading to cell death. Their use was substantially decreased in clinical practice from the 1970s to 2000s due to their significant nephrotoxicity and neurotoxicity compared to the newly introduced antibiotics. The increasing prevalence of multidrug-resistant gram-negative bacteria infections in this century has led to an upsurge in the use of these “older” drugs. Respiratory paralysis caused by neuromuscular blockage associated with the use of polymyxin B and E was reported mostly in literature published in the 1960s to 1970s with a few reports after 2000. In addition, such a reaction might be enhanced by the presence of other classes of drugs. We report a case of polymyxin B and E–induced apnea in a patient receiving “muscle relaxants.”

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“…Only one case according most recent literature have described a profound encephalopathy with lack of brainstem reflexes in postsurgical patient [5].…”

Section: Methodsmentioning

confidence: 99%

Colistin`s Dark Face. Resurrection of Polymyxin Antibiotics and Alternative Strategies

2017

AIDT

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Due to the lack of new antibiotics for the treatment of critically ill patients with multidrug-resistant bacteria, interest on “old” antibiotics like colistin (polymyxin E) re-emerged. This polymyxin has gained an important role as salvage therapy for patients infected with microorganisms susceptible only to colistin. It is important to know the dark face of colistin referring here to its important toxicity, often lethal, especially in critically ill patients. Given its rarity we briefly mentioned a case of profound encephalopathy in a post-surgical patient who recovered completely after stopping the drug. In addition, its variable pharmacokinetics make it very difficult to establish an effective regimen, most of which is infratherapeutic and with the limitation of its toxicity, which is a terrible problem for humanity. The common sense of the clinician and the birth of new antibiotics, as an alternative strategy, represent a hope to eradicate multiresistance.

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Colistin-mediated neurotoxicity

Cited by 12 publications

References 5 publications

Comparison of Short Versus Prolonged Infusion of Standard Dose of Meropenem Against Carbapenemase-Producing Klebsiella pneumoniae Isolates in Different Patient Groups: A Pharmacokinetic–Pharmacodynamic Approach

Comparison of Short Versus Prolonged Infusion of Standard Dose of Meropenem Against Carbapenemase-Producing Klebsiella pneumoniae Isolates in Different Patient Groups: A Pharmacokinetic–Pharmacodynamic Approach

Respiratory Muscle Paralysis Associated With Colistin, Polymyxin B, and Muscle Relaxants Drugs

Colistin`s Dark Face. Resurrection of Polymyxin Antibiotics and Alternative Strategies

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