Colistin is a complex
polypeptide antibiotic composed mainly of
colistin A and B. It was abandoned from clinical use in the 1970s because of significant renal and, to a lesser extent, neurological toxicity. Actually,
colistin is increasingly put forward as salvage or even first-line treatment for severe multidrug-resistant,
Gram-negative bacterial infections, particularly in the
intensive care setting. We reviewed the most recent literature on
colistin treatment, focusing on efficacy and toxicity issues. The method used for literature search was based on a PubMed retrieval using very precise criteria.Despite large variations in dose and duration,
colistin treatment produces relatively high clinical cure rates.
Colistin is potentially nephrotoxic but currently used criteria tend to overestimate the incidence of kidney injury. Nephrotoxicity independently predicts fewer cures of
infection and increased mortality. Total cumulative
colistin dose is associated with kidney damage, suggesting that shortening of
treatment duration could decrease the incidence of nephrotoxicity. Factors that may enhance
colistin nephrotoxicity (i.e.,
shock,
hypoalbuminemia, concomitant use of potentially nephrotoxic drugs) must be combated or controlled. Neurotoxicity does not seem to be a major issue during
colistin treatment. A better knowledge of
colistin pharmacokinetics in
critically ill patients is imperative for obtaining
colistin dosing regimens that ensure maximal antibacterial activity at minimal toxicity.