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Colistin Use in Patients with Chronic Kidney Disease : Are We Underdosing Patients?
- Source :
- Dipòsit Digital de Documents de la UAB, Universitat Autònoma de Barcelona, Molecules, Vol 24, Iss 3, p 530 (2019), Molecules, Volume 24, Issue 3
- Publication Year :
- 2019
-
Abstract
- Colistin is administered as its inactive prodrug colistimethate (CMS). Selection of an individualized CMS dose for each patient is difficult due to its narrow therapeutic window, especially in patients with chronic kidney disease (CKD). Our aim was to analyze CMS use in patients with CKD. Secondary objectives were to assess the safety and efficacy of CMS in this special population. In this prospective observational cohort study of CMS-treated CKD patients, CKD was defined as the presence of a glomerular filtration rate (GFR) &lt<br />60 mL/min/m2 for more than 3 months. The administered doses of CMS were compared with those recently published in the literature. Worsened CKD at the end of treatment (EOT) was evaluated with the RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease) criteria. Colistin plasma concentrations (Css) were measured using high-performance liquid chromatography. Fifty-nine patients were included. Thirty-six (61.2%) were male. The median age was 76 (45&ndash<br />95) years and baseline GFR was 36.6 &plusmn<br />13.6. The daily mean CMS dosage used was compared with recently recommended doses (3.36 vs. 6.07<br />p &lt<br />0.001). Mean Css was 0.9 (0.2&ndash<br />2.9) mg/L, and Css was &lt<br />2 mg/L in 50 patients (83.3%). Clinical cure was achieved in 43 (72.9%) patients. Worsened renal function at EOT was present in 20 (33.9%) patients and was reversible in 10 (52.6%). The CMS dosages used in this cohort were almost half those currently recommended. The mean achieved Css were under the recommended target of 2 mg/dL. Despite this, clinical cure rate was high. In this patient cohort, the incidence of nephrotoxicity was similar to those found in other recent studies performed in the general population and was reversible in 52.6%. These results suggest that CMS is safe and effective in patients with CKD and may encourage physicians to adjust dosage regimens to recent recommendations in order to optimize CMS treatments.
- Subjects :
- Male
Pharmaceutical Science
urologic and male genital diseases
Analytical Chemistry
0302 clinical medicine
Chronic kidney disease
Drug Discovery
Drug Dosage Calculations
030212 general & internal medicine
Prospective Studies
health care economics and organizations
Aged, 80 and over
0303 health sciences
education.field_of_study
Middle Aged
female genital diseases and pregnancy complications
3. Good health
Anti-Bacterial Agents
Treatment Outcome
Chemistry (miscellaneous)
Colistin plasma concentrations
Cohort
Pseudomonas aeruginosa
Urinary Tract Infections
Molecular Medicine
Female
Cohort study
medicine.drug
Glomerular Filtration Rate
medicine.medical_specialty
Dose
Population
Urology
Renal function
Pharmacokinetic
Toxicodynamic
Drug Administration Schedule
Article
Nephrotoxicity
lcsh:QD241-441
03 medical and health sciences
lcsh:Organic chemistry
health services administration
medicine
Pneumonia, Bacterial
Humans
Pseudomonas Infections
Physical and Theoretical Chemistry
Renal Insufficiency, Chronic
education
Bronchitis
Aged
030306 microbiology
business.industry
Colistin
Organic Chemistry
medicine.disease
business
Kidney disease
Subjects
Details
- Database :
- OpenAIRE
- Journal :
- Dipòsit Digital de Documents de la UAB, Universitat Autònoma de Barcelona, Molecules, Vol 24, Iss 3, p 530 (2019), Molecules, Volume 24, Issue 3
- Accession number :
- edsair.doi.dedup.....1a69e0fb14e2fef3fec120f06470d92f