Comparative Efficacy of Twice and Thrice Daily Colistin Administration in Critically Ill Patients Battling Multi-Drug Resistant Gram-Negative Infections: An Observational Study
Introduction: Colistin, a polymyxin antibiotic often reserved for treatment of multidrug-resistant Gram-negative infections, exhibits a narrow therapeutic index. Careful consideration of the pharmacokinetic (PK) and pharmacodynamic (PD) parameters of colistin is essential to maximize its efficac...
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| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Pasteur Institute of Iran
2024-03-01
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| Series: | Journal of Medical Microbiology and Infectious Diseases |
| Subjects: | |
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| Summary: | Introduction: Colistin, a polymyxin antibiotic often reserved for treatment
of multidrug-resistant Gram-negative infections, exhibits a narrow
therapeutic index. Careful consideration of the pharmacokinetic (PK) and
pharmacodynamic (PD) parameters of colistin is essential to maximize its
efficacy and minimize toxicity. Both thrice-daily and twice-daily
administration regimens have been employed, with critically ill patients
posing unique challenges regarding colistin's PK/PD. Methods: This
retrospective observational study compared the mortality rates, cure rates,
length of hospital stay, nephrotoxicity, and readmission rates associated with
thrice-daily and twice-daily administration of a fixed total daily dose of 9
million international units (MIU) of colistin in 151 critically ill patients with
multidrug-resistant Gram-negative infections. Propensity score matching
with a 1:5 case-control ratio was performed using XLSTAT software (by
Addinsoft), and outcomes were analysed using logistic regression analysis.
Results: Thrice-daily dosing of colistin was recorded in 125 patients, and
twice-daily dosing in 26 patients. A total of 73 patients were included in the
final analysis after propensity score matching. The 28-day mortality rates,
clinical cure rates, and microbiological failure rates were comparable
between the two groups (Odds ratio (OR) [95% confidence-interval (CI)] =
0.48 [0.07-3.46], P=0.467; 1.67 [0.31-8.90], P=0.548; 0.13 [0.001-19.5], P
= 0.428, respectively). Hospital readmission rates within 90 days (OR [95%
CI] = 1.05 [0.12-9.10], P=0.964) and duration of hospital stay (Beta
coefficient = 1.55, P=0.683) were also comparable between the two groups.
The incidence of nephrotoxicity-related AKI events during Colistin therapy
was significantly lower with the 4.5 MIU twice-daily regimen (OR [95% CI]
= 0.04 [0.004-0.35], P=0.004). Conclusion: Twice-daily colistin
administration significantly reduces the risk of nephrotoxicity-related AKI
events compared to thrice-daily administration in critically ill patients with
multidrug-resistant Gram-negative infections. |
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| ISSN: | 2345-5349 2345-5330 |