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Good tolerability of high dose colistin-based therapy in patients with haematological malignancies

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Abstract

Purpose

Colistin is usually the only drug fully active against multi-drug resistant Gram-negative bacteria, but its nephrotoxicity might limit its use. Recent pharmacokinetic/pharmacodynamic data suggest that high dose of colistin, preceded by a loading dose, are needed to maximize its antibacterial effect. The aim of this study was to determine the safety of high doses colistin, in haematology population.

Methods

A retrospective review of haematology patients who received high dose colistin-based therapy in years 2011–2016 was performed. Nephrotoxicity was assessed using RIFLE criteria.

Results

Thirty patients who received 38 courses of colistin were included in the study. Colistin was always administered together with other antibiotics. Colistin was well tolerated, with one case of neurological toxicity and one of cutaneous reaction. There were 22 (58%) treatment cycles without any nephrotoxicity, even though during 16 of these cycles other nephrotoxic drugs were administered. Severe (injury or failure) renal toxicity occurred during 6 (16%) treatment courses, requiring colistin discontinuation in 2 patients and colistin dose reduction in 1. Poorer renal function at baseline and younger age were the only variables associated with increased renal toxicity (p = 0.011 and p = 0.031, respectively). Overall mortality was 18% (7/38) and 29% (11/38) at 7 and 30 days after the treatment onset.

Conclusions

In adult haematology population, high dose colistin therapy is safe and efficacious, despite high frequency of concomitant nephrotoxic treatment.

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Authors and Affiliations

  1. Division of Infectious Diseases, Department of Health Sciences (DISSAL), IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy

    Sara Grignolo, Paola Tatarelli, Valerio Del Bono, Claudio Viscoli & Malgorzata Mikulska

  2. Chair of Hematology, Department of Internal Medicine (DiMI), IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy

    Fabio Guolo, Paola Minetto, Giulia Rivoli, Daniela Guardo, Filippo Ballerini & Marco Gobbi

  3. Division of Hematology and Hematopoietic Stem Cell Transplantation Unit, IRCCS San Martino-IST, Genoa, Italy

    Riccardo Varaldo, Francesca Gualandi & Annamaria Raiola

Authors
  1. Sara Grignolo
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  2. Paola Tatarelli
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  3. Fabio Guolo
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  4. Paola Minetto
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  5. Giulia Rivoli
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  6. Daniela Guardo
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  7. Valerio Del Bono
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  8. Riccardo Varaldo
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  9. Francesca Gualandi
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  10. Filippo Ballerini
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  11. Annamaria Raiola
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  12. Marco Gobbi
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  13. Claudio Viscoli
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  14. Malgorzata Mikulska
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Contributions

MM, VDB, RV, FG, FB, AR made substantial contributions to conception and design of the study; SG, PT, FG, PM, GR and DG made contributions to acquisition of data, and SG and PT to analysis and interpretation of data too. SG, PT and MM participated in drafting the article, MM, VDB, RV, FG, FB, AR, MG and CV revised it critically for important intellectual content. All authors gave final approval of the version to be submitted.

Corresponding author

Correspondence to Paola Tatarelli.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Grignolo, S., Tatarelli, P., Guolo, F. et al. Good tolerability of high dose colistin-based therapy in patients with haematological malignancies. Infection 45, 505–511 (2017). https://doi.org/10.1007/s15010-017-1010-7

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  • DOI: https://doi.org/10.1007/s15010-017-1010-7

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