The Effects of Renal Impairment, Peritoneal Dialysis, and Hemodialysis on Serum Sodium Colistimethate Levels

Goodwin, Norma J.

doi:10.7326/0003-4819-68-5-984

Cited by 70 publications

(29 citation statements)

References 15 publications

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“…Dosing guidelines for critically ill patients and those with renal insufficiency need to be reevaluated. One report noted a removal rate of colistimethate during peritoneal dialysis of 0.9 mg/h (64). While older studies did not find any effect of hemodialysis on colistimethate (64,112), the effect of highflux dialyzers is unknown.…”

Section: Dosing Guidelinesmentioning

confidence: 95%

“…One report noted a removal rate of colistimethate during peritoneal dialysis of 0.9 mg/h (64). While older studies did not find any effect of hemodialysis on colistimethate (64,112), the effect of highflux dialyzers is unknown. Similarly, there is negligible information concerning the effect of other forms of renal replacement therapy, including venovenous hemofiltration (105,150).…”

Section: Dosing Guidelinesmentioning

confidence: 95%

“…More prolonged administration of Coly-Mycin at 5 to 7 mg/kg/day of colistin base (equivalent to 12 to 16.8 mg/kg/day of colistimethate) produced higher serum levels (13 to 32 g/ml) (144). The serum half-life has been estimated to be ϳ3 to 4.5 h with normal renal function and increases with declining renal function (64,112,144). The data regarding Colomycin are similar: single doses of 2 to 4 mg/kg of colistimethate produced serum levels of 11 to 25 g/ml and urinary concentrations of 200 g/ml of bioactive colistin (119).…”

Section: Serum Concentrationsmentioning

confidence: 99%

“…Several older studies using Coly-Mycin noted levels of ϳ6 to 18 g/ml of bioactive colistin following a single dose of approximately 75 to 150 mg of colistin base, equivalent to 180 to 360 mg of colistimethate (Coly-Mycin M Parenteral package insert; Monarch Pharmaceuticals, Inc., Bristol, TN) (52,64,112). Urinary concentrations typically achieved levels of 250 to 500 g/ml (Coly-Mycin M Parenteral package insert; Monarch Pharmaceuticals, Inc., Bristol, TN) (52).…”

Section: Serum Concentrationsmentioning

confidence: 99%

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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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Section: Dosing Guidelinesmentioning

confidence: 95%

Section: Dosing Guidelinesmentioning

confidence: 95%

Section: Serum Concentrationsmentioning

confidence: 99%

Section: Serum Concentrationsmentioning

confidence: 99%

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Polymyxins Revisited

et al. 2008

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“…Colistin has excellent in vitro activity against many species of gram-negative organisms and was previously among the few agents used to treat serious infections due to Pseudomonas bacteremia. However, colistin use has been limited because it had limited clinical efficacy and significant nephrotoxicity and neurotoxicity (12,13,17,36). Hence, it was eventually replaced by gentamicin and carbenicillin, two safer and more effective agents.…”

mentioning

confidence: 99%

Colistin Is Effective in Treatment of Infections Caused by Multidrug-Resistant Pseudomonas aeruginosa in Cancer Patients

Hachem

Chemaly

Ahmar

et al. 2007

Antimicrob Agents Chemother

117

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The increasing incidence of infections caused by multidrug-resistant Pseudomonas aeruginosa is a worldwide health problem. Because no new antipseudomonal agents are expected to be available in the near future, we evaluated the safety and efficacy of colistin, an old drug with bactericidal activity against this organism. We collected clinical and demographic data on 95 cancer patients diagnosed with infections caused by multidrugresistant P. aeruginosa between January 2001 and January 2004 and treated with either colistin (colistin group) or at least one active antipseudomonal agent (a beta-lactam antibiotic or a quinolone) (control group). We compared the results obtained for both groups. Thirty-one patients had been treated with colistin and 64 had been treated with an antipseudomonal non-colistin-containing regimen. Compared with the control group, patients in the colistin group had a lower median age (52 and 62 years, respectively; P ‫؍‬ 0.012) but were more likely to have had nosocomial infections (87% and 64%, respectively; P ‫؍‬ 0.02). Twenty-five patients (81%) in the colistin group and 40 patients (63%) in the control group had an APACHE II score of >15 (P ‫؍‬ 0.074). The overall clinical response rates were 52% in the colistin group and 31% in the control group (P ‫؍‬ 0.055). Multiple logistic regression analysis showed that those patients treated with colistin were 2.9 times (95% confidence interval, 1.1 to 7.6 times) more likely than those in the control group to experience a clinical response to therapy (P ‫؍‬ 0.026). Colistin therapy was at least as effective and as safe a beta-lactam antibiotic or a quinolone in the treatment of infections caused by multidrug-resistant P. aeruginosa and, hence, may be a useful or preferred alternative therapy for this infection in cancer patients.

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A Practical Guide to Drug Usage in Adult Patients With Impaired Renal Function

Bennett¹

1970

JAMA

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The Effects of Renal Impairment, Peritoneal Dialysis, and Hemodialysis on Serum Sodium Colistimethate Levels

Cited by 70 publications

References 15 publications

Polymyxins Revisited

Polymyxins Revisited

Colistin Is Effective in Treatment of Infections Caused by Multidrug-Resistant Pseudomonas aeruginosa in Cancer Patients

A Practical Guide to Drug Usage in Adult Patients With Impaired Renal Function

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