Modified Colistin Regimen for Critically Ill Patients with Acute Renal Impairment and Continuous Renal Replacement Therapy

Chemotherapy ◽  
2017 ◽  
Vol 63 (1) ◽  
pp. 35-38 ◽  
Author(s):  
Pierantonio Menna ◽  
Emanuela Salvatorelli ◽  
Alessia Mattei ◽  
Dario Cappiello ◽  
Giorgio Minotti ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Multidrug Resistant ◽  
Gram Negative Bacteria ◽  
Loading Dose ◽  
Antibacterial Efficacy ◽  
Gram Negative ◽  
Colistin Methanesulfonate ◽  
Kidney Impairment

Colistin is a last resort antibiotic to treat multidrug-resistant Gram-negative bacteria infections. Colistin is administered intravenously in the form of its inactive prodrug colistin methanesulfonate (CMS). For patients with acute kidney impairment and continuous renal replacement therapy high extracorporeal clearance may cause a substantial removal of active colistin from the bloodstream, eventually decreasing its antibacterial efficacy. Currently recommended doses of CMS may therefore be inadequate for these patients. We report on the potential value of a modified regimen that adopts a loading dose of CMS (bolus of 9 MU vs. conventional 3 MU every 8 h), followed by maintenance (3 MU every 8 h). Preliminary pharmacokinetic evidence for the feasibility and efficacy of this regimen is described for 2 patients.

scholarly journals Pharmacokinetics of a loading dose of amikacin in septic patients undergoing continuous renal replacement therapy

2011 ◽  
Vol 37 (6) ◽  
pp. 531-535 ◽  
Author(s):  
Fabio Silvio Taccone ◽  
Daniel de Backer ◽  
Pierre-François Laterre ◽  
Herbert Spapen ◽  
Thierry Dugernier ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Loading Dose

scholarly journals Intra-pleural colistin methanesulfonate therapy for pleural infection caused by carbapenem-resistant Acinetobacter baumannii: a successful case report

2014 ◽  
Vol 6 (3) ◽  
Author(s):  
Muhammad Asim Rana ◽  
Basheer Abd El Rahaman ◽  
Ahmed Fouad Mady ◽  
Mohammed Al Odat ◽  
Abdurehman Al Harthy ◽  
...  
Keyword(s):  
Treatment Options ◽  
Multidrug Resistant ◽  
Antimicrobial Treatment ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Carbapenem Resistant ◽  
Unsuccessful Treatment ◽  
Successful Case ◽  
Pleural Infection ◽  
Colistin Methanesulfonate

Infections caused by carbapenem-resistant, Gram-negative bacteria are an increasing clinical challenge, since the antimicrobial treatment options are often limited to colistin methanesulfonate. No data are available regarding the pharmacokinetics of colistin in pleural fluid. We report the case of a 92-year old man with ventilator-associated pneumonia and pleurisy caused by <em>Acinetobacter</em> <em>baumannii</em> and <em>Escherichia coli</em>, which were both multidrug-resistant. After an unsuccessful treatment with intravenous colistin methanesulfonate and imipenem-cilastatin, the addition of intra-pleural colistin methanesulfonate to the intravenous treatment led to a prompt clinical, radiological and microbiological resolution. This is the first report of a successful use of intra-pleural colistin in the literature. The intra-pleural colistin therapy should be considered in selected cases of pleurisy caused by multi-resistant Gram-negative bacteria.

scholarly journals Population Pharmacokinetics of Colistin Methanesulfonate and Formed Colistin in Critically Ill Patients from a Multicenter Study Provide Dosing Suggestions for Various Categories of Patients

2011 ◽  
Vol 55 (7) ◽  
pp. 3284-3294 ◽  
Author(s):  
S. M. Garonzik ◽  
J. Li ◽  
V. Thamlikitkul ◽  
D. L. Paterson ◽  
S. Shoham ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Creatinine Clearance ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Multidrug Resistant ◽  
Parameter Estimates ◽  
Highly Active ◽  
Dosing Regimens ◽  
Colistin Methanesulfonate

ABSTRACTWith increasing clinical emergence of multidrug-resistant Gram-negative pathogens and the paucity of new agents to combat these infections, colistin (administered as its inactive prodrug colistin methanesulfonate [CMS]) has reemerged as a treatment option, especially for critically ill patients. There has been a dearth of pharmacokinetic (PK) data available to guide dosing in critically ill patients, including those on renal replacement therapy. In an ongoing study to develop a population PK model for CMS and colistin, 105 patients have been studied to date; these included 12 patients on hemodialysis and 4 on continuous renal replacement therapy. For patients not on renal replacement, there was a wide variance in creatinine clearance, ranging from 3 to 169 ml/min/1.73 m2. Each patient was treated with a physician-selected CMS dosage regimen, and 8 blood samples for PK analysis were collected across a dosage interval on day 3 or 4 of therapy. A linear PK model with two compartments for CMS and one compartment for formed colistin best described the data. Covariates included creatinine clearance on the total clearance of CMS and colistin, as well as body weight on the central volume of CMS. Model-fitted parameter estimates were used to derive suggested loading and maintenance dosing regimens for various categories of patients, including those on hemodialysis and continuous renal replacement. Based on our current understanding of colistin PK and pharmacodynamic relationships, colistin may best be used as part of a highly active combination, especially for patients with moderate to good renal function and/or for organisms with MICs of ≥1.0 mg/liter.

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