Colistin administration to pediatric and neonatal patients

Abstract

Emergence of multidrug-resistant Gram-negative nosocomial pathogens has led to resurgence of colistin use. Safety and efficacy data regarding colistin use in pediatric patients are sparse, while optimal dosage has not been defined. We present a case series of neonates and children without cystic fibrosis treated with various doses of colistin intravenously. The records of patients who received colistin in a tertiary-care hospital from January 2007 to March 2009 were reviewed. Thirteen patients (median age 5 years, range 22 days to 14 years) received 19 courses of colistin as treatment of pneumonia, central nervous system infection, bacteremia, or complicated soft tissue infection. The isolated pathogens were Acinetobacter baumannii, Enterobacter cloacae, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia. Daily dose of colistin (colistimethate) ranged between 40,000 and 225,000 IU/kg. Duration of administration ranged from 1 to 133 days. Other antimicrobials were co-administered in 18/19 courses. Increase of serum creatinine in one patient was associated with co-administration of colistin and gentamicin. Sixteen of 19 courses had a favorable outcome, and only two of the three deaths were infection-related. Colistin intravenous administration appears well tolerated even at higher than previously recommended doses and of prolonged duration.

Old agent, new experience: colistin use in the paediatric Intensive Care Unit—a multicentre study

“…A number of studies have been conducted on the systemic use of colistin in adults, mostly in critically ill patients [7][8][9]. However, information on the efficacy and safety of colistin therapy in children is limited [2,6,10]. The aim of this multicentre study was to investigate the efficacy and safety of colistin therapy in the treatment of serious nosocomial infections in paediatric Intensive Care Unit (PICU) patients.…”

Outcome of ventilator-associated pneumonia due to multidrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa treated with aerosolized colistin in neonates: a retrospective chart review

“…Recently, there have been several reports of successful treatment of MDR gram-negative bacterial VAP with aerosolized colistin in patients without cystic fibrosis [11,28,35]. Aerosolized delivery may be less toxic than intravenous colistin, but the available data on the safety and efficacy of aerosolized colistin are mostly from adult patients [8,9,23]. Here, we report our experience with aerosolized colistin treatment in two preterm and one term infants with MDR gram-negative bacterial VAP and discuss the new role of this antimicrobial agent in the new era of antibiotics and microorganisms.…”

Stenotrophomonas Infection in a Patient with Glucose-6-Phosphate Dehydrogenase Deficiency

“…13 Colistimethate has limited evidence for use in S maltophilia infections. In a recent case series, Iosifidis et al 14 reported their results with use of intravenous colistimethate in several pediatric patients. Two patients had S maltophilia susceptible to colistimethate.…”