Colistin: the re-emerging antibiotic for multidrug-resistant Gram-negative bacterial infections

• Published in: The Lancet infectious diseases Vol. 6; no. 9; pp. 589 - 601
• Main Authors: Li, Jian, Nation, Roger L, Turnidge, John D, Milne, Robert W, Coulthard, Kingsley, Rayner, Craig R, Paterson, David L
• Format: Journal Article
• Language: English
• Published: London Elsevier Ltd 01.09.2006; Lancet Publishing Group; Elsevier Limited
• Subjects: Anti-Bacterial Agents - therapeutic use; Antibacterial agents; Antibiotics; Antibiotics. Antiinfectious agents. Antiparasitic agents; Bacteria; Bacterial diseases; Biological and medical sciences; Colistin - administration & dosage; Colistin - pharmacokinetics; Colistin - therapeutic use; Dose-Response Relationship, Drug; Drug Resistance, Multiple; Gram-Negative Bacterial Infections - drug therapy; Humans; Infectious diseases; Medical sciences; Pharmacokinetics; Pharmacology. Drug treatments; Infection; Antibiotic; Colistin; Cyclic peptides; Polypeptide; Multiple resistance; Bacteriosis; Antibacterial agent; Gram negative bacteria
• ISSN: 1473-3099; 1474-4457
• DOI: 10.1016/S1473-3099(06)70580-1

Increasing multidrug resistance in Gram-negative bacteria, in particular Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae, presents a critical problem. Limited therapeutic options have forced infectious disease clinicians and microbiologists to reappraise the clinical application of colistin, a polymyxin antibiotic discovered more than 50 years ago. We summarise recent progress in understanding the complex chemistry, pharmacokinetics, and pharmacodynamics of colistin, the interplay between these three aspects, and their effect on the clinical use of this important antibiotic. Recent clinical findings are reviewed, focusing on evaluation of efficacy, emerging resistance, potential toxicities, and combination therapy. In the battle against rapidly emerging bacterial resistance we can no longer rely entirely on the discovery of new antibiotics; we must also pursue rational approaches to the use of older antibiotics such as colistin.