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The Use of Colistin for the Treatment of Multidrug-resistant Gram-negative Infections in Neonates and Infants

A Review of the Literature

Nakwan, Narongsak MD*; Chokephaibulkit, Kulkanya MD; Imberti, Roberto MD

The Pediatric Infectious Disease Journal: November 2019 - Volume 38 - Issue 11 - p 1107–1112
doi: 10.1097/INF.0000000000002448
Antimicrobial Reports

In this review, we report the available data regarding efficacy, safety and pharmacokinetics of colistin in the treatment of multidrug-resistant Gram-negative bacteria in neonates and infants. Seventeen clinical studies, involving 312 patients, and 3 pharmacokinetics studies were identified. Blood stream infection was the most common source of infection, followed by pneumonia and meningitis/ventriculitis. In most cases, colistin was administered in association with other antibiotics. The most common route of administration was intravenous, with colistimethate doses ranging from 25,000 to 225,000 IU/kg/day divided into 2 or 3 doses. A recent pharmacokinetic study suggested that the appropriate intravenous dose should be >150,000 IU/kg/day. Microbiologic cure was obtained in 94.2% of patients and survival was 76.6%. The combination of intraventricular and intravenous colistin should be used in meningitis/ventriculitis. Nebulized colistin should be used as adjunctive treatment, but not as monotherapy. Nephrotoxicity and apnea were reported in 5.8% and 3.9% of patients respectively.The use of colistin for multidrug-resistant Gram-negative infections in neonates and infants is effective and safe, but the quality of studies is moderate. The optimal intravenous dose should be higher than that indicated in most reports.

From the *Department of Pediatrics, Hat Yai Medical Education Centre, Hat Yai Hospital, Songkhla, Thailand

Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

Phase I Clinical Trials Unit and Experimental Therapy, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.

Accepted for publication July 11, 2019.

The authors have no funding or conflicts of interest to disclose.

Address for correspondence: Roberto Imberti, MD, Phase I Clinical Trials Unit and Experimental Therapy, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy. E-mail:

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