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Pharmacokinetic Characteristics and Limited Sampling Strategies for Therapeutic Drug Monitoring of Colistin in Patients With Multidrug-Resistant Gram-Negative Bacterial Infections

Kim, Eun Jung, MD*,†; Oh, Jaeseong, MD; Lee, Kyounghoon, MD§; Yu, Kyung-Sang, MD, PhD; Chung, Jae-Yong, MD, PhD; Hwang, Joo-Hee, MD*; Nam, Eun Young, MD*; Kim, Hyoung Sook, RPh; Kim, Moonsuk, MD*; Park, Jeong Su, MD, PhD§; Song, Kyoung-Ho, MD, PhD*,†; Kim, Eu Suk, MD, PhD*,†; Song, Junghan, MD, PhD§; Kim, Hong Bin, MD, PhD*,†

doi: 10.1097/FTD.0000000000000572
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Background: Colistin is increasingly used as the last therapeutic option for the treatment of multidrug-resistant, Gram-negative bacterial infections. To ensure safe and efficacious use of colistin, therapeutic drug monitoring (TDM) is needed due to its narrow therapeutic window. This study aimed to evaluate the pharmacokinetic (PK) characteristics of colistin and to guide TDM in colistin-treated patients in Korea.

Methods: In a prospective study, we analyzed PK characteristics in 15 patients who intravenously received colistin methanesulfonate twice per day. Colistin methanesulfonate doses were adjusted based on renal function of the subjects. The appropriate blood sampling points for TDM were evaluated by analyzing the correlations between the PK parameters and the plasma concentrations at each time point.

Results: The mean values for the minimum, maximum, and average concentrations (Cmin, Cmax, and Caverage) of colistin at steady state were 2.29, 5.5, and 3.38 mg/L, respectively. The dose-normalized Cmin, Cmax, Caverage, and area under the plasma concentration–time curve from 0 to the last measurable concentration (AUClast) showed negative correlations with the creatinine clearance. The combination of the 0- and 2-hour post-dose plasma concentrations was evaluated as the appropriate sampling point for TDM. Two patients reported nephrotoxic adverse events during colistin administration.

Conclusions: Our study clarifies the PK characteristics of successful colistin treatment using TDM. Further evaluations in a larger patient population are needed to confirm the clinical usefulness of colistin TDM.

*Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam

Department of Internal Medicine, Seoul National University College of Medicine, Seoul

Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul

§Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam

Department of Clinical Pharmacology and Therapeutics, Seoul National University Bundang Hospital, Seongnam

Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.

Correspondence: Eu Suk Kim, MD, PhD, Division of Infectious Diseases, Department of Internal Medicine, Seoul National University, Bungdang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea (e-mail: eskim@snubh.org).

Supported by a grant from the Seoul National University Bundang Hospital (grant number 02-2015-004).

This work was presented as an abstract (SUNDAY-213) at the ASM MICROBE 2017 conference, June 1–5, 2017, New Orleans, LA.

E. J. Kim and J. Oh contributed equally to this work.

The authors declare no conflict of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.drug-monitoring.com).

Received May 17, 2018

Accepted September 06, 2018

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