Colistin administration to pediatric and neonatal patients

• Published in: European journal of pediatrics Vol. 169; no. 7; pp. 867 - 874
• Main Authors: Iosifidis, Elias, Antachopoulos, Charalampos, Ioannidou, Maria, Mitroudi, Magda, Sdougka, Maria, Drossou-Agakidou, Vassiliki, Tsivitanidou, Maria, Roilides, Emmanuel
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.07.2010; Springer; Springer Nature B.V
• Subjects: Administration, Inhalation; Adolescent; Aerosols; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - therapeutic use; Antimicrobial agents; Bacteria; Biological and medical sciences; Child; Child, Preschool; Colistin - administration & dosage; Colistin - therapeutic use; Creatinine; Cross Infection - drug therapy; Cross Infection - microbiology; Cystic fibrosis; Drug dosages; Drug Resistance, Multiple, Bacterial; Female; General aspects; Gram-negative bacteria; Gram-Negative Bacterial Infections - drug therapy; Gram-Negative Bacterial Infections - microbiology; Hospitals; Human infectious diseases. Experimental studies and models; Humans; Infant; Infant, Newborn; Infectious diseases; Infusions, Intravenous; Injections, Intraventricular; Intensive care; Male; Medical sciences; Medicine; Medicine & Public Health; Nervous system; Nosocomial infections; Original Paper; Pathogens; Patients; Pediatrics; Pharmacokinetics; Pneumonia; Retrospective Studies; Treatment Outcome; Greece; Multidrug resistant; Intraventricular administration; Gram-negative bacteria; Nosocomial infections; Colistin; Colistimethate; Human; Nosocomial infection; Pediatrics; Neonatal; Treatment resistance; Cyclic peptides; Cerebral ventricle; Antibiotic; Newborn; Polypeptide; Multiple resistance; Antibacterial agent; Child; Gram negative bacteria
• ISSN: 0340-6199; 1432-1076
• DOI: 10.1007/s00431-009-1137-3

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.