Use of colistin in the treatment of multiple-drug-resistant gram-negative infections

Local Administration of Polymyxins into the Respiratory Tract for the Prevention and Treatment of Pulmonary Infections in Patients without Cystic Fibrosis

“…Among these attempts is the use of antibiotics directly to the respiratory tract in the form of aerosols. To the best of our knowledge there are only five recently published studies that have assessed the safety and effectiveness of aerosolized polymyxins for the treatment of MDR Gramnegative bacterial pneumonia in non cystic fibrosis patients [8,9,[29][30][31]. In table 2 we summarized all available demographic and clinical data reported in these five studies.…”

“…Moreover, in two case series of eight and three patients with nosocomial pneumonia or tracheobronchitis caused by MDR A. baumannii and P. aeruginosa, aerosolized CMS proved beneficial as a supplemental to the conventional therapy [9,30]. Recently, the administration of aerosolized CMS in various dosages ranging from 0.5 MIU every 6 h to 1 MIU every 8 h in 49 evaluable patients with nosocomial pneumonia for a mean (± SD) duration of 12 (± 8) days resulted in 100% microbiological eradication of A. baumannii and 57% of P. aeruginosa strains on follow-up cultures from broncholalveolar lavage, tracheal aspirates, bronchial brushing, and sputum [29]. The diagnosis of a lung infection was based on the presence of purulent sputum or tracheobronchial secretions; isolation of the causative organism from quantitative culture, and at least one of the following within 24 h before inhaled therapy was started: body temperature more than 38 °C, leukocytosis (more than 1.2 × 10 10 cells/ l) or leukopenia (fewer than 4.0 × 10 9 cells/l).…”

“…However, it is believed that avoiding the systemic exposure to polymyxins by their administration directly to the respiratory tract, nephrotoxicity and neurotoxicity are also eliminated. Evidence from the published experience with the use of aerosolized polymyxins showed that renal failure due to acute tubular necrosis and neuromuscular blockade resulting in apnea were not frequently developed [8,9,29,30]. Minor adverse effects that have been reported with aerosolized polymyxins include sore throat, cough, bronchoconstriction, and chest tightness.…”

Pharmacokinetics of Colistin Methansulphonate (CMS) and Colistin after CMS Nebulisation in Baboon Monkeys

“…In critical care patients, colistin aerosols are also used as an adjunctive treatment of nosocomial (3)(4)(5)(6) or ventilator-associated pneumonia (VAP) (7,8) due to multidrug-resistant Gram-negative such as P. aeruginosa and A. baumannii. Colistin is a multicomponent cationic polypeptide mainly constituted by colistin A (polymyxin E1) and colistin B (polymyxin E2).…”

Inhaled antibiotic therapy for ventilator-associated tracheobronchitis and ventilator-associated pneumonia: an Update

“…Treatment with inhaled colistin for infections due to multi-drug resistant Gram-negative infections.than that with parenteral colistin(Table 3).Most studies have been retrospective analyses of small number of patients81,83,[117][118][119][120][121][122] with pneumonia due to MDR Acinetobacter baumannii or Pseudomonas aeruginosa. Despite the serious nature of these infections, administration of inhaled colistin in addition to systemic antibiotic therapy (including parenteral colistin) provided encouraging results, with clinical and microbiological success in the majority of treated patients (Table 3).…”