Colistin: An Update on the Antibiotic of the 21st Century

Silpak Biswas; Jean-Michel Brunel; Jean-Christophe Dubus; Martine Reynaud-Gaubert; Jean-Marc Rolain


Expert Rev Anti Infect Ther. 2012;10(8):917-934. 

In This Article

Expert Commentary

The emergence of MDR bacteria that cause nosocomial infections poses a serious therapeutic problem. Interest in colistin use has increased dramatically in recent times because of the emergence of bacterial strains resistant to other clinically available antibiotics. The need for uniform dosing of CMS is necessary to avoid confusion. The optimal treatment dose according to the most recent PK data for systemic infections in adults ranges widely, between 240 and 720 mg daily (i.e., 3–9 × 106 IU/day) in two to four divided doses. Clinicians should be careful about the adverse effect of colistin use as monotherapy as well as combination therapy. Studies on the effectiveness of combination therapy compared with monotherapy should be carried out in a wide range of pathogenic bacterial isolates. Clinicians must choose colistin monotherapy or as combination as appropriate for the patients. Resistance to colistin should be reported immediately to screen for the resistance gene and to understand the molecular mechanism of resistance, which will provide a basis to recommend appropriate antibiotics. Furthermore, we must explore ways to maintain the usefulness and activity of colistin against MDR pathogens and to develop a new generation of such compounds to fight against the worrying emergence of MDR bacteria in the future.