Colistin serum concentrations after intravenous administration in critically ill patients with serious multidrug-resistant, gram-negative bacilli infections: A prospective, open-label, uncontrolled study

Μάρκου, Νικόλαος; Markantonis, Sophia L.; Dimitrakis, Efthimios; Panidis, Dimitrios; Boutzouka, Eleni; Karatzas, Stylianos; Rafailidis, Petros I.; Apostolakos, H; Baltopoulos, George

doi:10.1016/j.clinthera.2008.01.015

Cited by 181 publications

(162 citation statements)

References 29 publications

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“…Combination MICs of vancomycin and its structurally related compounds declined below the susceptibility break point in half of the isolates. Synergy was observed (FICI: ≤ 0.5), and the concentrations of the drugs in combination decreased below the minimal steady-state concentrations achieved with standard dosing regimens of colistin 11 and continuously infused vancomycin 12 and norvancomycin 13 . The effi cacy of low doses of colistin was also supported by the results of the time-kill assays.…”

Section: Discussionmentioning

confidence: 99%

“…Our research describes the in vitro synergistic activity of colistin in combination with some anti-Gram-positive bacterial agents against MDR A. baumannii. Colistin exhibits good activity against most Gram-negative bacteria, but it is not widely used due to concerns regarding toxicity and tolerability 11 . Several studies have reported poor outcomes in patients with MDR A. baumannii infections treated with colistin, which may be related to the pharmacokinetics and the pharmacodynamics of the drug and to the severity of the underlying illness in the treated patients 16 .…”

Section: Discussionmentioning

confidence: 99%

“…Colistin was added at 0.125μg/ml (1/4 MIC), vancomycin at 16μg/ml, and norvancomycin at 8μg/ ml to mimic the minimal steady-state concentrations achieved with standard dosing regimens of colistin methanesulfonate (1,000,000IU colistin) 11 and continuously infused vancomycin 12 and norvacomycin 13 . Linezolid was added at 8μg/ml, a concentration that mimics the minimal steady-state plasma concentration achieved with intravenous administration of 600mg/12h 14 .…”

Section: Time-kill Assaysmentioning

confidence: 99%

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Colistin and anti-Gram-positive bacterial agents against Acinetobacter baumannii

Liu

et al. 2014

Rev. Soc. Bras. Med. Trop.

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Introduction:Acinetobacter baumannii has attained an alarming level of resistance to antibacterial drugs. Clinicians are now considering the use of older agents or unorthodox combinations of licensed drugs against multidrug-resistant strains to bridge the current treatment gap. We investigated the in vitro activities of combination treatments that included colistin with vancomycin, norvancomycin or linezolid against multidrug-resistant Acinetobacter baumannii. Methods: The fractional inhibitory concentration index and time-kill assays were used to explore the combined effects of colistin with vancomycin, norvancomycin or linezolid against 40 clinical isolates of multidrug-resistant Acinetobacter baumannii. Transmission electron microscopy was performed to evaluate the interactions in response to the combination of colistin and vancomycin. Results: The minimum inhibitory concentrations (MICs) of vancomycin and norvancomycin for half of the isolates decreased below the susceptibility break point, and the MIC of linezolid for one isolate was decreased to the blood and epithelial lining fl uid concentration using the current dosing regimen. When vancomycin or norvancomycin was combined with subinhibitory doses of colistin, the multidrug-resistant Acinetobacter baumannii test samples were eradicated. Transmission electron microscopy revealed that subinhibitory doses of colistin were able to disrupt the outer membrane, facilitating a disruption of the cell wall and leading to cell lysis. Conclusions: Subinhibitory doses of colistin signifi cantly enhanced the antibacterial activity of vancomycin, norvancomycin, and linezolid against multidrug-resistant Acinetobacter baumannii.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Time-kill Assaysmentioning

confidence: 99%

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Colistin and anti-Gram-positive bacterial agents against Acinetobacter baumannii

Liu

et al. 2014

Rev. Soc. Bras. Med. Trop.

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“…The currently used dosage regimens of CMS generate suboptimal exposure to colistin in many critically ill patients, in particular in renally competent patients. Two studies reported low plasma colistin C max values following administration of 174 mg to 250 mg (2 to 3 MU) of CMS every 8 or 12 h, with steady-state levels of 1.15 to 5.14 g/ml or 0.68 to 4.65 g/ml, respectively (42). Moreover, a significant delay in obtaining steady-state plasma concentrations of formed colistin was reported for CMS treatment started without administration of a loading dose (43).…”

Section: Use Of Colistin In Human and Veterinary Medicine Use In Humamentioning

confidence: 99%

Polymyxins: Antibacterial Activity, Susceptibility Testing, and Resistance Mechanisms Encoded by Plasmids or Chromosomes

2017

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SUMMARY Polymyxins are well-established antibiotics that have recently regained significant interest as a consequence of the increasing incidence of infections due to multidrug-resistant Gram-negative bacteria. Colistin and polymyxin B are being seriously reconsidered as last-resort antibiotics in many areas where multidrug resistance is observed in clinical medicine. In parallel, the heavy use of polymyxins in veterinary medicine is currently being reconsidered due to increased reports of polymyxin-resistant bacteria. Susceptibility testing is challenging with polymyxins, and currently available techniques are presented here. Genotypic and phenotypic methods that provide relevant information for diagnostic laboratories are presented. This review also presents recent works in relation to recently identified mechanisms of polymyxin resistance, including chromosomally encoded resistance traits as well as the recently identified plasmid-encoded polymyxin resistance determinant MCR-1. Epidemiological features summarizing the current knowledge in that field are presented.

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“…A high proportion of clinician-selected dosing regimens result in sub-therapeutic colistin concentrations. [12,15,17,26,31,33] Of particular concern is a recent study showing that it is not possible to reach the modest target [2,43] colistin AUC/MIC of 60 in patients with creatinine clearances >70 ml/ min without exceeding the upper limit daily dose of 10 MU CMS recommended in the package insert. [17] …”

Section: Pharmacokineticpharmacodynamic Relationshipsmentioning

confidence: 99%

Systematic review of the evidence for rational dosing of colistin

2016

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Colistin serum concentrations after intravenous administration in critically ill patients with serious multidrug-resistant, gram-negative bacilli infections: A prospective, open-label, uncontrolled study

Cited by 181 publications

References 29 publications

Colistin and anti-Gram-positive bacterial agents against Acinetobacter baumannii

Colistin and anti-Gram-positive bacterial agents against Acinetobacter baumannii

Polymyxins: Antibacterial Activity, Susceptibility Testing, and Resistance Mechanisms Encoded by Plasmids or Chromosomes

Systematic review of the evidence for rational dosing of colistin

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