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. 2018;63(1):35-38.
doi: 10.1159/000484974. Epub 2017 Dec 22.

Modified Colistin Regimen for Critically Ill Patients with Acute Renal Impairment and Continuous Renal Replacement Therapy

Pierantonio Menna  1 , Emanuela Salvatorelli, Alessia Mattei, Dario Cappiello, Giorgio Minotti, Massimiliano Carassiti
Affiliations

Modified Colistin Regimen for Critically Ill Patients with Acute Renal Impairment and Continuous Renal Replacement Therapy

Pierantonio Menna et al. Chemotherapy. 2018.

Abstract

Colistin is a last resort antibiotic to treat multidrug-resistant Gram-negative bacteria infections. Colistin is administered intravenously in the form of its inactive prodrug colistin methanesulfonate (CMS). For patients with acute kidney impairment and continuous renal replacement therapy high extracorporeal clearance may cause a substantial removal of active colistin from the bloodstream, eventually decreasing its antibacterial efficacy. Currently recommended doses of CMS may therefore be inadequate for these patients. We report on the potential value of a modified regimen that adopts a loading dose of CMS (bolus of 9 MU vs. conventional 3 MU every 8 h), followed by maintenance (3 MU every 8 h). Preliminary pharmacokinetic evidence for the feasibility and efficacy of this regimen is described for 2 patients.

Keywords: Area under the curve; Colistin; Loading dose; Minimum inhibitory concentration.

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