High-Dose, Extended-Interval Colistin Administration in Critically Ill Patients: Is This the Right Dosing Strategy? A Preliminary Study

Dalfino, Lidia; Puntillo, Filomena; Mosca, Adriana; Monno, Rosa; Spada, M.; Coppolecchia, Sara; Miragliotta, G.; Bruno, Francesco; Brienza, Nicola

doi:10.1093/cid/cis286

Cited by 224 publications

(209 citation statements)

References 37 publications

(60 reference statements)

Supporting

Mentioning

180

Contrasting

Unclassified

Order By: Relevance

“…intravenous polymyxins alone in MDR GNB infections, most of which were pneumonias. It's indicated that the mortality ranged from 0% to 74.3% (4,21,(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37), clinical response (cure and improvement) rate 7-82.1%, and microbiological eradication 27.3-73.9% (24,(33)(34)(35)(36)(37)(38). In respect to the colistin only susceptible strains, it's reported that the mortality in hospitals of intravenous colistin monotherapy was 50% (16/32) (Figure 2), 11 patients died in Intensive Care Unit (ICU) (39), and clinical cure was obtained in 82.1% of infectious episodes (23/28) and bacteriological clearance was achieved in 73.9% (17/23) of the cured infectious episodes (38).…”

Section: Combination Therapymentioning

confidence: 99%

“…Toxicities associated with colistin do not appear to increase with use of a loading dose (38,46). Limited clinical evidence is available.…”

Section: Loading Dosesmentioning

confidence: 99%

“…Limited clinical evidence is available. In a preliminary study (38), critically ill patients with 28 infectious episodes, received a loading CMS dose of 9 MU, followed by a maintenance dose of 4.5 MU every 12 hours. Clinical cure was observed in 23 cases (82.1%).…”

Section: Loading Dosesmentioning

confidence: 99%

See 2 more Smart Citations

Intravenous polymyxins: Revival with puzzle

Fei

et al. 2017

BST

View full text Add to dashboard Cite

Section: Combination Therapymentioning

confidence: 99%

“…Toxicities associated with colistin do not appear to increase with use of a loading dose (38,46). Limited clinical evidence is available.…”

Section: Loading Dosesmentioning

confidence: 99%

See 1 more Smart Citation

Intravenous polymyxins: Revival with puzzle

Fei

et al. 2017

BST

View full text Add to dashboard Cite

“…However, extended dosing intervals may lead to periods of low colistin concentrations allowing for resistant subpopulations to occur within a microbial population susceptible to colistin (heteroresistance). [28][29][30]34] Small, uncontrolled studies report good efficacy, without significant renal toxicity, of high-dose CMS regimens given 12-hourly [35] or daily. [31] There are no randomised, controlled, clinical trials (RCTs) evaluating the efficacy and safety of once-, twice-and thrice-daily dosing of colistin.…”

Section: Dosing Intervalmentioning

confidence: 99%

Systematic review of the evidence for rational dosing of colistin

2016

View full text Add to dashboard Cite

“…3,45,47,63 A recently-published prospective observational study in intensive care unit patients with severe infections due to Gram-negative bacteria susceptible only to colistin recorded clinical cures in 82% of cases when colistin was administered as a 9-million-unit loading dose followed by 9 million units daily, given in two doses, as maintenance therapy. 64 Combination of colistin/polymyxin B with other agents to which the bacteria show in vitro sensitivity is strongly encouraged (e.g. with aminoglycosides and/or tigecycline for the treatment of infections due to Klebsiella pneumoniae with KPC carbapenemases).…”

mentioning

confidence: 99%

Targeted therapy against multi-resistant bacteria in leukemic and hematopoietic stem cell transplant recipients: guidelines of the 4th European Conference on Infections in Leukemia (ECIL-4, 2011)

et al. 2013

View full text Add to dashboard Cite

The detection of multi-resistant bacterial pathogens, particularly those to carbapenemases, in leukemic and stem cell transplant patients forces the use of old or non-conventional agents as the only remaining treatment options. These include colistin/polymyxin B, tigecycline, fosfomycin and various anti-gram-positive agents. Data on the use of these agents in leukemic patients are scanty, with only linezolid subjected to formal trials. The Expert Group of the 4 th European Conference on Infections in Leukemia has developed guidelines for their use in these patient populations. Targeted therapy should be based on (i) in vitro susceptibility data, (ii) knowledge of the best treatment option against the particular species or phenotype of bacteria, (iii) pharmacokinetic/pharmacodynamic data, and (iv) careful assessment of the risk-benefit balance. For infections due to resistant Gram-negative bacteria, these agents should be preferably used in combination with other agents that remain active in vitro, because of suboptimal efficacy (e.g., tigecycline) and the risk of emergent resistance (e.g., fosfomycin). The paucity of new antibacterial drugs in the near future should lead us to limit the use of these drugs to situations where no alternative exists. ABSTRACT © F e r r a t a S t o r t i F o u n d a t i o n 2 0 1 3organizing committee and experts were solicited to form the working group. The group reviewed the published English-language literature and prepared proposals on treatment options for infections due to resistant bacteria. Papers for review were sought using PubMed with the terms "linezolid", "daptomycin", "quinupristin/ dalfopristin", "colistin or polymyxin", "tigecycline", "fosfomycin", "telavancin", "ceftaroline" AND "stem cell transplantation or bone marrow transplant or leukemia or hematological malignancy or cancer". References cited in the articles identified were also considered. In respect of 'Duration of therapy', the main search terms used were "antibiotic therapy"; "stem cell transplantation or bone marrow transplantation or hematological malignancy or cancer"; "febrile neutropenia" and "duration therapy", "discontinuation antibiotics" and "microbiologically documented infection". Definitions of resistanceA bacterial isolate was considered non-susceptible if it was categorized resistant, intermediate or non-susceptible when using clinical breakpoints of the European Committee on Antimicrobial Susceptibility Testing (EUCAST), Clinical and Laboratory Standards Institute (CLSI) or the US Food and Drug Administration (FDA). Definitions of 'MDR' vary among authors and usually presume resistance to at least two antibiotics used in empiric therapy (3 rd 4 th -generation cephalosporins, carbapenems or piperacillin/tazobactam) or resistance to at least three of the following antibiotic classes: antipseudomonal penicillins, cephalosporins, carbapenems, aminoglycosides and fluoroquinolones. [11][12][13][14][15] According to the recent definition of the European Centre for Disease Prevention and Control...

show abstract

High-Dose, Extended-Interval Colistin Administration in Critically Ill Patients: Is This the Right Dosing Strategy? A Preliminary Study

Cited by 224 publications

References 37 publications

Intravenous polymyxins: Revival with puzzle

Intravenous polymyxins: Revival with puzzle

Systematic review of the evidence for rational dosing of colistin

Targeted therapy against multi-resistant bacteria in leukemic and hematopoietic stem cell transplant recipients: guidelines of the 4th European Conference on Infections in Leukemia (ECIL-4, 2011)

Contact Info

Product

Resources

About