Safety and efficacy of colistin compared with imipenem in the treatmentof ventilator-associated pneumonia: a matched case–control study

Kallel, Hatem; Hergafi, Leila; Bahloul, Mabrouk; Hakim, Ahmed; Dammak, Hassen; Chelly, Hédi; Hamida, Chokri Ben; Chaari, Anis; Rekik, Noureddine; Bouaziz, Mounir

doi:10.1007/s00134-007-0675-2

Cited by 143 publications

(91 citation statements)

References 22 publications

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“…Several studies, most of them with small samples, have shown good outcomes in patients with VAP due to MDRAcinetobacter spp. treated with colistin [9], high-dose ampicillin-sulbactam [10], tetracyclines [11](doxycycline or minocycline) or aerosolized tobramycin [12]. However, the recorded clinical experience with these antibiotics is still limited and the reported studies of their use in the treatment of VAP are not randomized controlled clinical trials.…”

Section: Discussionmentioning

confidence: 99%

Indications of a new antibiotic in clinical practice: results of the tigecycline initial use registry

et al. 2008

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Tigecycline is the first of a new class of antibiotics named glycylcyclines and it was approved for the treatment of complicated intra-abdominal infections and complicated skin and skin structure infections. Notwithstanding this, tigecycline's pharmacological and microbiological profile which includes multidrug-resistant pathogens encourages physicians' use of the drug in other infections. We analyzed, during the first months after its launch, the tigecycline prescriptions for 113 patients in 12 institutions. Twenty-five patients (22%) received tigecycline for approved indications, and 88 (78%) for "off label" indications (56% with scientific support and 22% with limited or without any scientific support). The most frequent "off label" use was ventilator associated pneumonia (VAP) (63 patients). The etiology of infections was established in 105 patients (93%). MDR-Acinetobacter spp. was the microorganism most frequently isolated (50% of the cases). Overall, attending physicians reported clinical success in 86 of the 113 patients (76%). Our study shows that the "off label" use of tigecycline is frequent, especially in VAP. due to MDRAcinetobacter spp., where the therapeutic options are limited (eg: colistin). Physicians must evaluate the benefits/ risks of using this antibiotic for indications that lack rigorous scientific support.

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Section: Discussionmentioning

confidence: 99%

Indications of a new antibiotic in clinical practice: results of the tigecycline initial use registry

et al. 2008

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“…8 This study is a 7-year cohort and various different doses of colistin were used. In the past, we would administer colistin at low doses, based on several reports regarding the nephrotoxicity of the drug.…”

Section: Page 11 Of 22mentioning

confidence: 99%

“…polymyxins (colistin and polymyxin B), an antibiotic class discovered more that 60 years ago that had been abandoned for nearly 20 years, except for in the distinct population of patients with cystic fibrosis [2]. A number of recently published clinical studies have suggested that colistin may be considered in the treatment of patients with MDR Gram-negative bacterial infections [3][4][5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Colistin therapy for microbiologically documented multidrug-resistant Gram-negative bacterial infections: a retrospective cohort study of 258 patients

Falagas¹,

Rafailidis²,

Ioannidou³

et al. 2010

International Journal of Antimicrobial Agents

272

201

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“…The mortality rate was reported to be between 20% and 70% in ventilator-associated pneumonia (VAP) [2][3][4]. Treatment often consists of using colistin with another antibiotic belonging to another group without taking the antibiotic resistance pattern into consideration.…”

Section: Introductionmentioning

confidence: 99%

Colistin alone or combined with sulbactam or carbapenem against A. baumannii in ventilator-associated pneumonia

Yilmaz

Güven

Güner

et al. 2015

J Infect Dev Ctries

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Introduction: Colistin use has increased over the last ten years because of multidrug-resistant microorganisms. The aim of this study was to compare the clinical and microbiological efficacy of colistin alone or in combination with sulbactam or carbapenem in the treatment of ventilator-associated pneumonia (VAP) due to multidrug-resistant (MDR) and extremely drug-resistant (XDR) A. baumannii. Methodology: Cases treated for VAP because of MDR and XDR A. baumannii between January 2011 and January 2013 were included in the study. The primary and secondary outcome for colistin alone, colistin with sulbactam, and colistin with carbapenems were evaluated. The primary outcomes were clinical efficacy and microbiological efficacy; the secondary outcomes were nephrotoxicity, length of hospitalization, and mortality. Results: A total of 70 VAP patients were evaluated. A total of 17 patients (24.3%) were administered colistin alone, 20 patients (28.6%) were administered colistin and sulbactam, and 33 patients (47.1%) were administered colistin and carbapenem. Clinical and microbiological response rates were higher in the carbapenem combination group (63.6% and 63.6% in both) than in the sulbactam combination group, which registered 55.0% and 60.0%, respectively. However, this did not represent a significant difference statistically (p > 0.05). There was also no significant difference between colistin alone and the combination groups regarding clinical and microbiological efficacy and mortality. Conclusions: Neither the administration of colistin alone nor colistin combined with either sulbactam or carbapenem had any noticeable advantage in the treatment of VAP in terms of clinical response, microbiological response, nephrotoxicity, length of hospitalization, and mortality.

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Safety and efficacy of colistin compared with imipenem in the treatmentof ventilator-associated pneumonia: a matched case–control study

Abstract: We conclude that colistin can be a safe and effective option in the treatments of VAP caused by pan-drug-resistant P. aeruginosa or A. baumanii.

Cited by 143 publications

References 22 publications

Indications of a new antibiotic in clinical practice: results of the tigecycline initial use registry

Indications of a new antibiotic in clinical practice: results of the tigecycline initial use registry

Colistin therapy for microbiologically documented multidrug-resistant Gram-negative bacterial infections: a retrospective cohort study of 258 patients

Colistin alone or combined with sulbactam or carbapenem against A. baumannii in ventilator-associated pneumonia

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