Renal and neurological side effects of colistin in critically ill patients

Abstract

Colistin is a complex polypeptide antibiotic composed mainly of colistin A and B. It was abandoned from clinical use in the 1970s because of significant renal and, to a lesser extent, neurological toxicity. Actually, colistin is increasingly put forward as salvage or even first-line treatment for severe multidrug-resistant, Gram-negative bacterial infections, particularly in the intensive care setting. We reviewed the most recent literature on colistin treatment, focusing on efficacy and toxicity issues. The method used for literature search was based on a PubMed retrieval using very precise criteria.Despite large variations in dose and duration, colistin treatment produces relatively high clinical cure rates. Colistin is potentially nephrotoxic but currently used criteria tend to overestimate the incidence of kidney injury. Nephrotoxicity independently predicts fewer cures of infection and increased mortality. Total cumulative colistin dose is associated with kidney damage, suggesting that shortening of treatment duration could decrease the incidence of nephrotoxicity. Factors that may enhance colistin nephrotoxicity (i.e., shock, hypoalbuminemia, concomitant use of potentially nephrotoxic drugs) must be combated or controlled. Neurotoxicity does not seem to be a major issue during colistin treatment. A better knowledge of colistin pharmacokinetics in critically ill patients is imperative for obtaining colistin dosing regimens that ensure maximal antibacterial activity at minimal toxicity.

Intravenous Colistin Use for Multidrug-Resistant Gram-Negative Infections in Pediatric Patients

“…However current studies reported that this adverse effect is lesser. Although neurotoxicity is reported, studies showed this adverse effect in a less degree (6,7). The data of the efficacy and safety of colistin use in children is scarce.…”

Effectiveness and Safety of Colistin in Multi Drug Resistant Urinary Tract Infections

“…The incidence of renal toxicity in our study was found to be 36.3% (29/80). But reported value (Spapen H et al, 2011) in the literature goes up to 53.5 %. Colistin can cause acute tubular necrosis manifested as a rise in serum creatinine and a decrease in creatinine clearance.…”

Systematic review of the evidence for rational dosing of colistin

“…[39] Colistin's nephrotoxicity is dose-dependent and mostly mild and reversible. [25,38,40] One study showed that rates of nephrotoxicity were significantly higher in patients receiving daily maintenance doses greater than the equivalent of 12 MU of CMS in a 70 kg patient. [38] Colistin's exact mechanism of nephrotoxicity is not established.…”

“…[38] Colistin's exact mechanism of nephrotoxicity is not established. [11,12,40,41] Patients with abnormal renal function at the start of colistin therapy have consistently been identified as being at high risk for nephrotoxic events. [28] General measures to limit colistin's nephrotoxicity include regular monitoring of renal function with appropriate dose adjustment (especially with prolonged use), adequate hydration and limited use of concomitant nephrotoxic drugs.…”