Safety and Tolerability of Bolus Intravenous Colistin in Acute Respiratory Exacerbations in Adults with Cystic Fibrosis

@article{Conway2000SafetyAT,
  title={Safety and Tolerability of Bolus Intravenous Colistin in Acute Respiratory Exacerbations in Adults with Cystic Fibrosis},
  author={Steven P. Conway and Christine Etherington and Jim Munday and Martin Harris Goldman and J J Strong and Mandy Wootton},
  journal={Annals of Pharmacotherapy},
  year={2000},
  volume={34},
  pages={1238 - 1242}
}
OBJECTIVE: To assess the safety and tolerability of bolus intravenous doses of colistin during acute respiratory exacerbations in adults with cystic fibrosis and chronic Pseudomonas aeruginosainfection. METHODS: Twelve patients with acute exacerbations of cystic fibrosis were enrolled in a Phase I open-label study. On day 1, patients received three doses of colistin 2 mega-units (160 mg), reconstituted in 50 mL of NaCl 0.9%, by infusion over 30 minutes three × daily. On days 2, 3, and 4, the… 

Tables from this paper

Optimization of anti‐pseudomonal antibiotics for cystic fibrosis pulmonary exacerbations: IV. colistimethate sodium

An evidence‐based summary of pharmacokinetic/pharmacodynamic, tolerability, and efficacy studies utilizing the intravenous (IV) polymixin antibiotic colistimethate sodium (CMS) in the treatment of APE is provided to identify areas where further study is warranted.

Combination Therapy with Intravenous Colistin for Management of Infections Due to Multidrug-Resistant Gram-Negative Bacteria in Patients without Cystic Fibrosis

The use of intravenous colistin for the treatment of infections due to multidrug-resistant gram-negative bacteria appears to be safe and effective, and the absence of a control group constitutes the major limitations of this study.

The clinical use of colistin in patients with cystic fibrosis

  • P. Beringer
  • Medicine, Biology
    Current opinion in pulmonary medicine
  • 2001
Current data supports the use of intravenous colistimethate for the treatment of acute pulmonary exacerbations involving MDR P. aeruginosa infections in patients with cystic fibrosis and recent pharmacokinetic and pharmacodynamic data suggests new intravenous dosing regimens may enhance efficacy while minimizing toxicities.

Toxicity after prolonged (more than four weeks) administration of intravenous colistin

Serum creatinine, blood urea, liver function tests, symptoms and signs of neurotoxicity were the main outcomes studied and no serious toxicity was observed in this group of patients who received prolonged intravenous colistin.

Steady-state pharmacokinetics of intravenous colistin methanesulphonate in patients with cystic fibrosis.

Based on the in vitro pharmacodynamics against Pseudomonas aeruginosa previously published by this group and these pharmacokinetic findings, dose escalating trials may be warranted to maximize efficacy.

Colistimethate Sodium Dry Powder for Inhalation: A Review of Its Use in the Treatment of Chronic Pseudomonas aeruginosa Infection in Patients with Cystic Fibrosis

In conclusion, colistimethate sodium DPI administered via the Turbospin® inhaler is a useful option for the treatment of chronic P. aeruginosa infection in patients with CF aged ≥6 years.

Intravenous colistin in the treatment of sepsis from multiresistant Gram-negative bacilli in critically ill patients

The lack of a control group in the present study does not allow any definite conclusions to be drawn regarding the clinical effectiveness of colistin, but this drug has an acceptable safety profile and its use should be considered in severe infections with multiresistant Gram-negative bacilli.

Colistimethate sodium for the treatment of chronic pulmonary infection in cystic fibrosis: an evidence-based review of its place in therapy

This article reviews the available evidence to reflect on the place of colistimethate sodium in the therapy of chronic pulmonary infection in CF.

The use of colistin in Cystic Fibrosis

Early clinical reports of severe toxicity with the use of colistin are likely to have occurred as a result of inappropriate patient selection, higher than recommended doses and inappropriate monitoring.

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

Colistin was used in 80 patients infected with A. baumannii or P. aeruginosa and appeared to be efficacious and safe, and there were no significant changes in mean serum urea or creatinine concentrations in patients receiving i.v. or i.m. therapy.

References

SHOWING 1-10 OF 23 REFERENCES

Intravenous colistin sulphomethate in acute respiratory exacerbations in adult patients with cystic fibrosis.

Assessment of the individual effect of each treatment regimen suggests a greater efficacy when colistin is combined with a second antibiotic to which the pseudomonas shows in vitro sensitivity, and changes in renal function should be monitored.

Toxicity of Colistin in Cystic Fibrosis Patients

It appears that intravenous colistin can be considered for cystic fibrosis patients with strains of P. aeruginosa that are resistant to more commonly used antibiotics.

Four years' experience of intravenous colomycin in an adult cystic fibrosis unit.

In the authors' experience intravenous colomycin sulphomethate in moderate doses is an effective and safe antipseudomonal antibiotic which is easy to administer and other clinicians should consider its use in patients with cystic fibrosis.

Home versus hospital intravenous antibiotic therapy in the treatment of young adults with cystic fibrosis.

Treatment of exacerbations of cystic fibrosis at home or in hospital is, thus, equally effective given proper patient selection and adequate monitoring of the response to treatment.

Neurotoxic and nephrotoxic effects of colistin in patients with renal disease.

Potentially serious reactions to colistin§ are described in 3 adults with impaired kidney function and in a child who was given ten times the recommended dosage.

Effects of Large Doses of Colistin Sulphomethate Sodium on Renal Function

High doses of colistin were used in the treatment of severely ill patients with refractory klebsiella chest and urinary tract infections and in all patients it produced acute renal failure and in some acute tubular necrosis.

Reduction of sputum Pseudomonas aeruginosa density by antibiotics improves lung function in cystic fibrosis more than do bronchodilators and chest physiotherapy alone.

We evaluated patients with cystic fibrosis (CF) and moderate obstructive lung disease in pulmonary exacerbation in a double-blind placebo-controlled trial to determine the contribution of

A reassessment of the in-vitro activity of colistin sulphomethate sodium.

The results show that colistin remains a useful antimicrobial agent against Gram-negative bacteria, particularly those strains which are resistant to more commonly used antibiotics.

A guide to use of antibiotics in patients with renal disease. A table of recommended doses and factors governing serum levels.

  • C. Kunin
  • Medicine
    Annals of internal medicine
  • 1967
Excerpt The complexity of antimicrobial therapy has increased as new drugs and the analogues of older agents have grown in number. Clinical practice has also been complicated by the necessity to us...