Roger L Nation1, Jian Li. 1. Facility for Anti-infective Drug Development and Innovation, Drug Delivery, Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, Melbourne, Australia. roger.nation@pharm.monash.edu.au
Abstract
PURPOSE OF REVIEW: Colistin is a 50-year-old antibiotic that is being used increasingly as a 'last-line' therapy to treat infections caused by multidrug-resistant Gram-negative bacteria, when essentially no other options are available. Despite its age, or because of its age, there has been a dearth of knowledge on its pharmacological and microbiological properties. This review focuses on recent studies aimed at optimizing the clinical use of this old antibiotic. RECENT FINDINGS: A number of factors, including the diversity in the pharmaceutical products available, have hindered the optimal use of colistin. Recent advances in understanding of the pharmacokinetics and pharmacodynamics of colistin, and the emerging knowledge on the relationship between the pharmacokinetics and pharmacodynamics, provide a solid base for optimization of dosage regimens. The potential for nephrotoxicity has been a lingering concern, but recent studies provide useful new information on the incidence, severity and reversibility of this adverse effect. Recent approaches to the use of other antibiotics in combination with colistin hold promise for increased antibacterial efficacy with less potential for emergence of resistance. SUMMARY: Because few, if any, new antibiotics with activity against multidrug-resistant Gram-negative bacteria will be available within the next several years, it is essential that colistin is used in ways that maximize its antibacterial efficacy and minimize toxicity and development of resistance. Recent developments have improved use of colistin in the 21st century.
PURPOSE OF REVIEW: Colistin is a 50-year-old antibiotic that is being used increasingly as a 'last-line' therapy to treat infections caused by multidrug-resistant Gram-negative bacteria, when essentially no other options are available. Despite its age, or because of its age, there has been a dearth of knowledge on its pharmacological and microbiological properties. This review focuses on recent studies aimed at optimizing the clinical use of this old antibiotic. RECENT FINDINGS: A number of factors, including the diversity in the pharmaceutical products available, have hindered the optimal use of colistin. Recent advances in understanding of the pharmacokinetics and pharmacodynamics of colistin, and the emerging knowledge on the relationship between the pharmacokinetics and pharmacodynamics, provide a solid base for optimization of dosage regimens. The potential for nephrotoxicity has been a lingering concern, but recent studies provide useful new information on the incidence, severity and reversibility of this adverse effect. Recent approaches to the use of other antibiotics in combination with colistin hold promise for increased antibacterial efficacy with less potential for emergence of resistance. SUMMARY: Because few, if any, new antibiotics with activity against multidrug-resistant Gram-negative bacteria will be available within the next several years, it is essential that colistin is used in ways that maximize its antibacterial efficacy and minimize toxicity and development of resistance. Recent developments have improved use of colistin in the 21st century.
Authors: Jian Li; Craig R Rayner; Roger L Nation; Roxanne J Owen; Denis Spelman; Kar Eng Tan; Lisa Liolios Journal: Antimicrob Agents Chemother Date: 2006-09 Impact factor: 5.191
Authors: Jian Li; Roger L Nation; John D Turnidge; Robert W Milne; Kingsley Coulthard; Craig R Rayner; David L Paterson Journal: Lancet Infect Dis Date: 2006-09 Impact factor: 25.071
Authors: Cristina Miglis; Nathaniel J Rhodes; Sean N Avedissian; Christine J Kubin; Michael T Yin; Brian C Nelson; Manjunath P Pai; Marc H Scheetz Journal: Antimicrob Agents Chemother Date: 2018-02-23 Impact factor: 5.191
Authors: Hui He; Ji-Chang Li; Roger L Nation; Jovan Jacob; Gong Chen; Hee Ji Lee; Brian T Tsuji; Philip E Thompson; Kade Roberts; Tony Velkov; Jian Li Journal: J Antimicrob Chemother Date: 2013-06-07 Impact factor: 5.790
Authors: Victor I Band; Emily K Crispell; Brooke A Napier; Carmen M Herrera; Greg K Tharp; Kranthi Vavikolanu; Jan Pohl; Timothy D Read; Steven E Bosinger; M Stephen Trent; Eileen M Burd; David S Weiss Journal: Nat Microbiol Date: 2016-05-09 Impact factor: 17.745