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Intravenous Colistimethate (Colistin) Use in Critically Ill Children Without Cystic Fibrosis

Falagas, Matthew E. MD, MSc, DSc*†‡; Sideri, Georgia MD§; Vouloumanou, Evridiki K. MD*; Papadatos, John H. MD, PhD§; Kafetzis, Dimitris A. MD, PhD

The Pediatric Infectious Disease Journal: February 2009 - Volume 28 - Issue 2 - p 123-127
doi: 10.1097/INF.0b013e31818a5dbd
Original Studies

Introduction: The increasing frequency of infections caused by multidrug-resistant (MDR) Gram-negative bacteria has led to the reappraisal of colistimethate use.

Methods: We present a case series of critically ill pediatric patients without cystic fibrosis who received intravenous colistimethate treatment. All available relevant medical records were reviewed.

Results: Seven children without cystic fibrosis (mean age 7.7 years; 2 female), admitted to the intensive care unit of a tertiary-care pediatric hospital in Athens, Greece, were identified to have received intravenous colistimethate during October 2004 to May 2008. MDR Acinetobacter baumannii, Pseudomonas aeruginosa, and/or Klebsiella pneumoniae were isolated from blood and/or bronchial secretions specimens in 6 of 7 reported patients. All isolates were susceptible to colistin. All 7 patients received intravenous colistimethate in a dosage of 5 mg/kg daily (divided in 3 equal doses, administered every 8 hours). Five children received colistimethate for 10 days and the remaining 2 for 2 and 23 days, respectively. The infections caused by MDR Gram-negative bacteria were improved in 6 children with microbiologically documented infections. Five of the 7 children were discharged from the ICU. The remaining 2 children died (1 of them had received colistimethate for 2 days); their death was not attributed to MDR Gram-negative infection. No nephrotoxicity or other type of toxicity of colistimethate was noted in this case-series.

Conclusions: Although the small number of included cases precludes any firm conclusions, our study suggests that colistimethate may have a role for the treatment of infections caused by MDR Gram-negative bacteria in critically ill pediatric patients.

From the *Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece; †Department of Medicine, Henry Dunant Hospital, Athens, Greece; ‡Department of Medicine, Tufts University School of Medicine, Boston, MA; §Pediatric Intensive Care Unit, P. & A. Kyriakou Children's Hospital, Athens, Greece; and ¶Second Department of Pediatrics, University of Athens, P. & A. Kyriakou Children's Hospital, Athens, Greece.

Accepted for publication August 13, 2008.

Address for correspondence: Matthew E. Falagas, MD, MSc, DSc, Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos St, 151 23 Marousi, Greece. E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.