Colistin and neurotoxicity: recommendations for optimal use in cystic fibrosis patients
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Case description The use of i.v. colistin reappeared recently for the treatment of multidrug-resistant Gram negative organisms in the intensive care and cystic fibrosis (CF) setting. According to the latest pharmacokinetic data, a loading dose and high antibiotic doses are given. Two cases of adverse events (paraesthesias, bad taste) were observed immediately after the start of infusion of a high dose of i.v. colistin in adult CF patients at the Ghent University Hospital. Conclusion Recommendations for optimal administration of i.v. colistin in adult CF patients are scarce. This article highlights the importance of mode of administration to avoid toxicity and relates it to recent pharmacokinetic/-dynamic literature.
KeywordsAdministration ADR Adverse drug reaction Colistin Cystic fibrosis Intravenous Neurotoxicity
We acknowledge Professor William Couet, Poitiers, France, for his valuable reflection on the possibility to assess pharmacokinetic information.
Conflicts of interest
- 2.Plachouras D, Karvanen M, Friberg LE, Friberg LE, Papadomichelakis E, Antoniadou A, et al. Population pharmacokinetic analysis of colistin methanesulfonate and colistin after intravenous administration in critically ill patients with infections caused by gram-negative bacteria. Antimicrob Agents Chemother. 2009;53:3430–6.PubMedCentralPubMedCrossRefGoogle Scholar
- 3.Garonzik SM, Li J, Thamlikitkul V, Paterson DL, Shoham S, Jacob J, et al. Population pharmacokinetics of colistin methanesulfonate and formed colistin in critically ill patients from a multicenter study provide dosing suggestions for various categories of patients. Antimicrob Agents Chemother. 2011;55:3284–94.PubMedCentralPubMedCrossRefGoogle Scholar
- 4.Grégoire N, Mimoz O, Mégarbane B, Comets E, Chatelier D, Lasocki S, Gauzit R, Balayn D, Gobin P, Marchand S, Couet W. New colistin population pharmacokinetic data in critically ill patients suggesting an alternative loading dose rational. Antimicrob Agents Chemother. 2014;58(12):7324–30.Google Scholar
- 9.Sorlí L, Luque S, Grau S, Berenguer N, Segura C, Montero MM, Alvarez-Lerma F, Knobel H, Benito N, Horcajada JP. Trough colistin plasma level is an independent risk factor for nephrotoxicity: a prospective observational cohort study. BMC Infect Dis. 2013;13:380.PubMedCentralPubMedCrossRefGoogle Scholar