Intravenous colistimethate (colistin) use in critically ill children without cystic fibrosis.

Abstract

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.

• Authors: Matthew E Falagas, Georgia Sideri, Evridiki K Vouloumanou, John H Papadatos, Dimitris A Kafetzis
• Journal: The Pediatric infectious disease journal (Pediatr Infect Dis J) Vol. 28 Issue 2 Pg. 123-7 (Feb 2009) ISSN: 0891-3668 [Print] United States
• PMID: 19116601 (Publication Type: Journal Article)

Chemical References

• Anti-Bacterial Agents
• Colistin

Topics

• Adolescent
• Anti-Bacterial Agents (therapeutic use)
• Child
• Child, Preschool
• Colistin (administration & dosage, therapeutic use)
• Critical Illness
• Cystic Fibrosis
• Drug Resistance, Multiple, Bacterial
• Female
• Gram-Negative Bacteria (drug effects)
• Gram-Negative Bacterial Infections (drug therapy)
• Humans
• Infant
• Infant, Newborn
• Injections, Intravenous
• Male