Hæmophilus Influenzæ Meningitis Treated With Polymyxin

Swift, P. N.; Bushby, S. R. M.

doi:10.1016/s0140-6736(51)91437-7

Cited by 21 publications

(8 citation statements)

References 25 publications

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“…Clinical evidence for using only intravenous colistin for the treatment of MDR Gram-negative bacterial CNS infections remains controversial up to now [10,19,29]. For this reason, there is a low threshold for intrathecal therapy with colistin in patients having meningitis, and most of the published studies have shown good efficacy both in adults and children [10,15,19,23,28,38,40].…”

Section: Discussionmentioning

confidence: 99%

Colistin administration to pediatric and neonatal patients

Iosifidis¹,

Antachopoulos²,

Ioannidou³

et al. 2010

Eur J Pediatr

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Emergence of multidrug-resistant Gram-negative nosocomial pathogens has led to resurgence of colistin use. Safety and efficacy data regarding colistin use in pediatric patients are sparse, while optimal dosage has not been defined. We present a case series of neonates and children without cystic fibrosis treated with various doses of colistin intravenously. The records of patients who received colistin in a tertiary-care hospital from January 2007 to March 2009 were reviewed. Thirteen patients (median age 5 years, range 22 days to 14 years) received 19 courses of colistin as treatment of pneumonia, central nervous system infection, bacteremia, or complicated soft tissue infection. The isolated pathogens were Acinetobacter baumannii, Enterobacter cloacae, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia. Daily dose of colistin (colistimethate) ranged between 40,000 and 225,000 IU/kg. Duration of administration ranged from 1 to 133 days. Other antimicrobials were co-administered in 18/19 courses. Increase of serum creatinine in one patient was associated with co-administration of colistin and gentamicin. Sixteen of 19 courses had a favorable outcome, and only two of the three deaths were infection-related. Colistin intravenous administration appears well tolerated even at higher than previously recommended doses and of prolonged duration.

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Section: Discussionmentioning

confidence: 99%

Colistin administration to pediatric and neonatal patients

Iosifidis¹,

Antachopoulos²,

Ioannidou³

et al. 2010

Eur J Pediatr

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“…While cure with intravenous colistimethate therapy alone has been documented (53, 77, 78, 96, 115), several reports noted failures with systemic therapy (8,22,50,133,183). Numerous case reports demonstrated successful outcomes with intraventricular or intrathecal instillation of colistimethate or polymyxin B in children (12,30,39,50,70,128,133,143,164,176,183) and adults (8,11,22,50,57,66,82,117,120,128,141,142,154,163,175,180,183) with or without corresponding intravenous therapy (Table 7). Given the fact that peak CSF levels of colistin approximate the MIC for most multidrug-resistant P. aeruginosa and A. baumannii strains (77,78), clinicians should have a low threshold for the administration of intrathecal or intraventricular therapy, especially if prompt improvement does not occur with intravenous therapy.…”

Section: Clinical and Microbiological Outcomesmentioning

confidence: 99%

Polymyxins Revisited

et al. 2008

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SUMMARY The global emergence of multidrug-resistant gram-negative bacilli has spurred a renewed interest in polymyxins. Once discarded due to concerns regarding nephrotoxicity and neurotoxicity, polymyxins now hold an important role in the antibiotic armamentarium. However, more reliable information is needed to determine the optimal dosing of these agents. Also, unanswered questions regarding in vitro testing remain, including questions regarding the reliability of automated systems and the establishment of appropriate breakpoints for defining susceptibility. Most contemporary clinical studies examining the use of these agents have involved patients with infections due to multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii strains. It has been reassuring that polymyxin therapy for resistant bacteria has resulted in clinical responses and toxicity rates similar to those for carbapenem therapy for susceptible isolates. While most surveillance studies demonstrated high rates of susceptibility, several reports noted the emergence of polymyxin-resistant nosocomial pathogens. Polymyxins have assumed an important antibiotic niche for therapy for hospital-acquired infections; further studies defining the optimal use of these agents will likely extend the duration of their clinical usefulness.

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“…Among these, 25 articles (10 case series and 15 case reports) qualified for inclusion in this review . The 10 case series included in the review presented a total of 355 children [49,52,[57][58][59]62,63,65,67,68] and the 15 case reports presented 15 children [44][45][46][47][48]50,51,[53][54][55][56]60,61,64,66]. The detailed process of the selection of eligible trials is depicted graphically in Fig.…”

Section: Selected Studiesmentioning

confidence: 99%

“…Nine case series including a total of 311 children who received colistin for the treatment of infections caused by pathogens susceptible to colistin were identified [49,52,58,59,62,63,65,67,68]. The main characteristics of these nine case series, including demographic characteristics (age, sex) of the included children, any underlying disease and/or intervention, the type of infection, the isolated pathogens, any antibiotic treatment prior to colistin, the characteristics of colistin treatment (formulation, dosage, duration), any concomitant treatment to colistin, the clinical outcome of each patient and any reported adverse events, are summarised in Table 1.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%