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How to Use Colistin in the ICU

De Pascale, Gennaro MD; Antonelli, Massimo MD

doi: 10.1097/CPM.0000000000000098
Critical Care

Colistin is a 50-year-old antibiotic that is being increasingly used as a rescue strategy for the treatment of patients affected by multidrug-resistant bacteria, especially in critically ill patients. Despite this molecule having been used for a long time, there is a relevant lack of knowledge regarding its pharmacokinetic and microbiologic activity. The introduction of new techniques able to measure colistin concentration after colistin methanesulfonate hydrolysis has strongly influenced the use of this drug in the clinical practice. Loading doses, higher daily dosages, and new administration schedules have been largely implemented in the Intensive Care Unit setting in addition to the aid of new administration routes (ie, aerosolization and intraventicular/intrathecal therapies). Combination treatments, mainly with carbapenems, have also been proposed, but clinical data showing clear benefits are still lacking. The historical concern for colistin-associated adverse effects (in particular renal toxicity) has reduced recently, in light of the results from several large reports addressing this issue. The aim of this review was to summarize and focus the updated clinical aspects of colistin administration in critically ill patients.

Department of Intensive Care and Anesthesiology, Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy

Disclosure: The authors declare that they have no conflicts of interest.

Address correspondence to: Massimo Antonelli, MD, Policlinico Universitario A. Gemelli Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, Rome 00168, Italy. E-mail:

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