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

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

Disclosures

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

In This Article

Clinical Uses of Colistin

For parenteral use, colistin is administered as colistin methanesulfonate or CMS. The use of colistin methanesulfonate began in the early 1990s, and it was administered intravenously and by inhalation to manage infections with P. aeruginosa in children and adult patients with CF. Treatment with colistin methanesulfonate or CMS has been described for the past 10–15 years. Most of thses studies were associated with MDR pathogens such as A.baumannii, P. aeruginosa and carbapenem-resistant K. pneumoniae. Most of the research outcomes on the treatment of patients with colistin methanesulfonate were acceptable considering the severity of infection and patient illnesses due to the MDR bacteria.

Recently, the largest cohort study by Falagas et al. on intravenous colistin showed that colistin is a valuable antibiotic with acceptable nephrotoxicity and considerable effectiveness that depends on the daily dosage and infection site.[124] This study reported colistin therapy for 258 patients who received intravenous colistin for at least 72 h for MDR Gram-negative bacterial infections, comprising 65.9% A. baumannii, 26.4% P. aeruginosa, 7.0% K. pneumoniae, 0.4% Stenotrophomonas maltophilia and 10.4% Enterobacter cloacae. In total, 79.1% of patients were cured and nephrotoxicity was found in 10% of patients. The effectiveness of colistin was not dependent on the type of pathogen.

Kwa et al. described 175 cases of non-CF patients who mostly had pneumonia and who were given intravenous PMB for infections caused by MDR Gram-negative bacteria, with clinical response rates ranging from 47.3 to 5%.[14]

Colistin has also been used recently to treat ventilator-associated pneumonia (VAP) and bacteremia caused by MDR bacteria, such as P. aeruginosa, K. pneumoniae and A. baumannii.[10,15] Alhough the use of colistin is considered to be effective, other antibiotics are often used in combination with colistin.[3,125] Many studies have shown good outcomes for patients treated with colistin alone or in combination with other antimicrobials for pneumonia cases.[126,127]

Garnacho-Montero et al. performed a preliminary evaluation of 35 cases of VAP caused by A. baumannii that were treated with intravenous colistin or imipenem.[128] A clinical cure was reported in 57% of patients. These findings indicate that polymyxins are as effective as carbapenems, although colistin-resistant clinical isolates of A. baumannii have already been reported in recent studies.[129,130] In another study, Kallel et al. determined the efficacy and safety of colistin in the treatment of VAP caused by pan-drug-resistant A.baumanii or P. aeruginosa.[131] Sixty patients included in this study were treated by colistin intravenously. A favorable clinical response to antibiotic therapy for VAP occurred in 45 patients (75%). None of the patients developed renal failure in this study, and their results showed that colistin can be a safe and effective option in the treatment of VAP caused by P. aeruginosa or A. baumanii.

Recently, Cho et al. reported the effectiveness of colistin in the treatment of major burn patients in South Korea.[132] López-Alvarez et al.[133] and Dalgic et al.[134] suggested that intraventricular administration of CMS is effective for the treatment of ventriculitis caused by MDR A. baumannii.

The effectiveness of CMS was studied by Hachem et al.[135] in 95 cancer patients diagnosed with infections caused by MDR P.aeruginosa. Inhalation of colistin methanesulfonate, or CMS, has been used over the last two decades, and recently Falagas et al.[136] and Michalopoulos et al.[137] reported the use of CMS in critically ill and intensive care unit patients for the treatment of VAP.

A recent case–control study by Kuo et al. demonstrated that inhaled CMS enhanced the eradication of MDR A. baumannii from the respiratory tract without significant clinical adverse effect or impact on colistin resistance.[138]

In short, contemporary clinical studies have demonstrated that treatment with colistin methanesulfonate could be a better option than no treatment.

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