Colistin sulfate versus sodium colistimethate.

Annals of internal medicine (Impact Factor: 17.81). 02/1969; 70(1):232-3. DOI: 10.7326/0003-4819-70-1-232_2
Source: PubMed
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    ABSTRACT: Although not much pharmacokinetic knowledge is available, polymyxin B is increasingly used for treatment of infections caused by gram-negative bacteria that are resistant to all other antibiotics. This study involved 8 patients who received intensive care after intravenous administration of a 60-min infusion of polymyxin B at currently recommended doses. Blood and urine samples were collected, and plasma protein binding of polymyxin B was determined. Concentrations of polymyxin B in plasma and urine samples were measured by a specific high-performance liquid chromatographic method. Polymyxin B was well tolerated. The peak plasma concentrations at the end of the infusion varied from 2.38 to 13.9 mg/L. For 4 patients from whom it was possible to collect urine samples over a dosing interval, only 0.04%-0.86% of the dose was recovered in the urine in unchanged form. Plasma protein binding of polymyxin B was higher in samples from patients (range, 78.5%-92.4%) than in plasma samples from healthy human subjects (mean +/- standard deviation, 55.9% +/- 4.7%). Unbound plasma concentrations of polymyxin B were in the vicinity of or lower than the minimum inhibitory concentration of the pathogen. To our knowledge, this is the first study to report plasma concentrations over time and urinary recovery of polymyxin B in critically ill patients after intravenous administration. Polymyxin B is eliminated mainly by nonrenal pathways, and the total body clearance appears to be relatively insensitive to renal function. Additional investigations are required to assess the appropriateness of currently recommended doses of this drug for the treatment of severe infections in critically ill persons.
    Preview · Article · Nov 2008 · Clinical Infectious Diseases
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    ABSTRACT: Colistin is a venerable antibiotic whose fortunes have been revived by its excellent activity, the diminishing output of novel clinically effective antibiotics and the increasing importance of MDR infection in burn surgery, both in the civilian and military arenas. This review synthesizes current evidence on the usage of colistin in burn surgery including the structure-activity relationship; dosing, pharmacokinetics/pharmacodynamic (PK/PD), analytic methods, resistance and current research efforts into the redevelopment of this antibiotic, to distil recommendations for future research and clinical efficacy.
    Full-text · Article · Aug 2012 · Burns: journal of the International Society for Burn Injuries
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    ABSTRACT: Central nervous system infections caused by Gram-negative bacteria susceptible only to colistin are rare but life-threatening and increasing in prevalence. Given the current antibiotic development pipeline it is likely that the paucity of therapeutic options will continue for the next years. Colistin is an amphipathic bactericidal antibiotic which is administered systemically as colistin methanesulfonate (also known as colistimethate sodium). Colistin methanesulfonate is the inactive prodrug, and in cerebrospinal fluid undergoes spontaneous hydrolysis to colistin (the active form with antimicrobial activity). In this review, we describe and evaluate the clinical and experimental data supporting the use of intraventricular (IVT) or intrathecal (IT) colistin against multidrug-resistant Gram-negative infections of the central nervous system, describe the permeability of the blood-brain barrier to colistin, the pharmacokinetics of colistin after IVT administration of colistin methanesulfonate, its anti-endotoxin activity, discuss the opportunity to administer colistin intraventricularly or intrathecally and the dose regimen, and provide recommendations based on the available evidence.
    No preview · Article · Mar 2014 · Expert Review of Anti-infective Therapy
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