Continuous Renal Replacement Therapy-Related Strategies to Avoid Colistin Toxicity: A Clinically Orientated Review

Honoré, Patrick M.; Jacobs, Rita; Joannès-Boyau, Olivier; Lochy, Stijn; Boer, Willem; Waele, Elisabeth De; Gorp, Viola Van; Regt, Jouke De; Collin, Vincent; Spapen, Herbert D.

doi:10.1159/000363495

Cited by 31 publications

(25 citation statements)

References 23 publications

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“…Therefore, some authors [28] postulate that patients undergoing continuous renal replacement therapy may receive substantially higher doses of colistin (i.e. a high loading dose, followed by a maintenance dose of up to 4.5 MIU twice daily).…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Toxicity of High-Dose Colistin in Multidrug-Resistant Gram-Negative Bacilli Infections: A Comparative Study of a Matched Series

et al. 2016

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Background: Colistimethate sodium (CMS) is the commercialized form of colistin that is effective against multiresistant Gram-negative bacilli. Its main side effects are nephrotoxicity and neurotoxicity. Pharmacodynamic dosages showed that they were infratherapeutic. Therefore, strategies with higher doses were proposed. The aim of this study was to assess the efficiency and toxicity of higher-dose CMS by comparing two treatment strategies: high-dose CMS versus standard-dose CMS. Methods: A prospective and comparative study of two matched groups was conducted. Fourty-six patients in each group were matched for age, severity and nature of infection. In the high-dose colistin group, CMS was administered at a loading dose of 9 MIU followed by a maintenance dose of 4.5 MIU/12 h. In the second group, retrospectively analyzed, colistin was administered at 6 MIU/day. For each group, clinical results, bacteriological eradication and daily creatinine clearance were recorded. Primary outcome measures were clinical cure defined as disappearance of infectious signs and eradication of microorganisms in all the follow-up cultures. Secondary outcome measures were incidence of acute renal failure and mortality. Results: Ninety-two patients were analyzed by matching. There was a higher cure rate in the high-dose group (63 vs. 41.3%, p = 0.04). No higher risk of nephrotoxicity was found by increasing daily doses of colistin (32.2 versus 26%, p = 0.64). Similarly, there was no significant difference in the time to onset of renal failure (8.32 vs. 11 days, p = 1) or in the requirement of hemodialysis (26.6 vs. 41%, p = 1). Conclusion: The high-dose colistin regimen is more efficient, without significant renal or neurological toxicity.

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Section: Discussionmentioning

confidence: 99%

Efficacy and Toxicity of High-Dose Colistin in Multidrug-Resistant Gram-Negative Bacilli Infections: A Comparative Study of a Matched Series

et al. 2016

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“…Colistin undergoes extensive renal tubular reabsorption (up to 80 %) and most of the filtered colistin is retained in the body, and is therefore cleared mainly by non-renal mechanisms [2,38].…”

Section: Mechanism Of Nephrotoxicitymentioning

confidence: 99%

A review on colistin nephrotoxicity

Javan

Shokouhi

Sahraei

2015

Eur J Clin Pharmacol

200

132

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Colistin is a nephrotoxic antibiotic; a worldwide increase in nosocomial infections has led to an increase in its usage. Nephrotoxicity is the concerning adverse effect of this drug. The mechanism of nephrotoxicity is via an increase in tubular epithelial cell membrane permeability, which results in cation, anion and water influx leading to cell swelling and cell lysis. There are also some oxidative and inflammatory pathways that seem to be involved in colistin nephrotoxicity. Risk factors of colistin nephrotoxicity can be categorized as dose and duration of colistin therapy, co-administration of other nephrotoxic drugs, and patient-related factors such as age, sex, hypoalbuminemia, hyperbilirubinemia, underlying disease and severity of patient illness.

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“…Instead, medium cut-off membranes (e.g. cut-off at 50,000 Da) which cause negligible albumin loss should be preferred [ 51 ].…”

Section: High Cut-off Membranesmentioning

confidence: 99%

Continuous Renal Replacement Therapy in Sepsis: Should We Use High Volume or Specific Membranes?

Honoré

Jacobs

Spapen

2015

Acute Nephrology for the Critical Care Physician

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Continuous Renal Replacement Therapy-Related Strategies to Avoid Colistin Toxicity: A Clinically Orientated Review

Cited by 31 publications

References 23 publications

Efficacy and Toxicity of High-Dose Colistin in Multidrug-Resistant Gram-Negative Bacilli Infections: A Comparative Study of a Matched Series

Efficacy and Toxicity of High-Dose Colistin in Multidrug-Resistant Gram-Negative Bacilli Infections: A Comparative Study of a Matched Series

A review on colistin nephrotoxicity

Continuous Renal Replacement Therapy in Sepsis: Should We Use High Volume or Specific Membranes?

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