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Monographs of Topical Drugs that Have Caused Contact Allergy/Allergic Contact Dermatitis
Published in Anton C. de Groot, Monographs in Contact Allergy, 2021
Colistimethate is a broad-spectrum polymyxin antibiotic active against most aerobic gram-negative bacteria except Proteus bacteria. This agent is a mixture of methanesulfonate derivatives of the cyclic polypeptides colistin A and B from Bacillus colistinus or B. polymyxa. Colistimethate is indicated for the treatment of acute or chronic infections due to sensitive strains of certain gram-negative bacilli, particularly Pseudomonas aeruginosa. It may also be employed for ear and ocular infections (1).
Adverse Reactions to Antibiotics in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Diane M. Parente, Cheston B. Cunha, Michael Lorenzo
The “To Err Is Human” report published in 1999 shed light on the alarming frequency of avoidable medical errors, and since its publication, significant efforts have been undertaken to improve the safety of patient care by reducing medications errors [4]. While some anti-infective-associated adverse events can be the result of a medication error (e.g., acute renal failure due to a patient receiving colistin dosing based on colistin base when the intended dose was based on the salt colistimethate sodium), the unavoidable necessity of anti-infective use in the CCU represents a significant challenge in assuring patient safety, as adverse events may be present even in the most vigilant monitoring and risk mitigation strategies. For this reason, it behooves clinicians in the CCU setting to be familiar with common anti-infective adverse events and be able to recognize such events in a timely manner to avoid undue patient harm [5,6]. The following chapter includes a summary of adverse events seen with anti-infectives commonly utilized in the adult critical care arena. Discussions of adverse events secondary to anti-retrovirals and direct acting antivirals used to treat the human immunodeficiency virus and viral hepatitis are excluded. Similarly, anti-infectives that are unlikely to be used in critically ill patients (e.g., nitrofurantoin and oral cephalosporins) and those unavailable in the US market are excluded. Some of the work included in this chapter is adapted from the work of Granowitz and Brown [7].
Cystic fibrosis infection and biofilm busters
Published in Anthony J. Hickey, Heidi M. Mansour, Inhalation Aerosols, 2019
Jennifer Fiegel, Sachin Gharse
In Europe, colistimethate sodium, a prodrug that hydrolyzes in the lungs to its active form, colistin, a cyclic polypeptide antibiotic, is used as the last line of defense against multidrug resistant gram-negative organisms (28). Colistin has demonstrated very low resistance rates against P. aeruginosa compared to other antibiotics (36,37). It is administered intravenously or via inhalation (the European Union only) as the prodrug colistimethate sodium (CMS), which is less toxic and has fewer side effects than the non-prodrug form (38). It is not FDA approved for use via inhalation in the United States due to the death of a patient from overdosing on a premixed solution, which led to dosing with a high bioactive concentration. CMS dry powder (Colobreathe DPI®) is well tolerated in adult and younger patients (28,39).
Polymyxin combination therapy for multidrug-resistant, extensively-drug resistant, and difficult-to-treat drug-resistant gram-negative infections: is it superior to polymyxin monotherapy?
Published in Expert Review of Anti-infective Therapy, 2023
Abdollah Ardebili, Ahdieh Izanloo, Mostafa Rastegar
Polymyxins are not absorbed from the gastrointestinal tract [90]. Polymyxin B can be given parenterally, intravenously, and topically as sulfate salts. It has also been administered intrathecally and intraventricularly for central nervous system infections. Commercially, colistin is available as two forms of colistin sulfate and colistin methanesulfonate (CMS; or colistimethate sodium). Colistin sulfate is used topically and orally, while CMS has been the most commonly used form of polymyxin for parenteral therapy. It has also been used for nebulization therapy in patients with cystic fibrosis (CF) and for intrathecal and intraventricular injection [91]. CMS is an inactive pro-drug that undergoes hydrolysis to convert into active colistin as well as a complex mixture of partially sulfomethylated derivatives in both in vitro aqueous media and in vivo biological fluids, taking several hours to achieve effective colistin concentrations [89,92,93].
Pharmacotherapeutic advances for recurrent urinary tract infections in women
Published in Expert Opinion on Pharmacotherapy, 2020
Mohamad Moussa, Mohamed Abou Chakra, Athanasios Dellis, Yasmin Moussa, Athanasios Papatsoris
The polymyxin antibiotics [colistin (CS) and polymyxin B (PMB)] are increasingly used as a last-line option for the treatment of drug-resistant Gram-negative bacteria. Despite having similar structures and antibacterial activity in vitro, the two clinically available polymyxins have very different pharmacological properties, as colistin (polymyxin E) is intravenously administered to patients in the form of an inactive prodrug colistin methanesulphonate (sodium). The pharmacokinetics of CS is influenced by renal function. Since CS is mainly excreted by the kidneys with high levels of CS throughout the urinary tract, it may be a better option than PMB for the treatment of UTIs [131]. Several studies have proven satisfactory safety profiles with intravenous CS 160 mg 3 times/day in patients with normal renal function. Adverse effects such as paresthesias, visual alterations, ataxia, and neuromuscular blockade are possible with polymyxin antibiotics. These neurologic effects, however, are usually reversible after the cessation of treatment and usually occur in patients receiving prolonged treatment. The recommended dose for patients weighing more than 60 kg is 1–2 million IU 3 times/day, equivalent to colistimethate sodium 80–160 mg 3 times/day, with a recommended daily upper limit of 6 million IU, or 480 mg of colistimethate sodium [132].
Outcome and factors of patients with nosocomial meningitis by multi-drug-resistant Gram-negative bacteria in a tertiary hospital in China: a retrospective study
Published in British Journal of Neurosurgery, 2020
Yue Chen, Fengtian Li, Man Zhu, Lei Liu, YanPing Luo
Nosocomial meningitis requires rapid initiation of effective antimicrobial treatment.9 The guideline3 recommended meropenem as the first-line choice; for strains that demonstrate carbapenem resistance, colistimethate sodium or polymyxin B (either agent administered by the intravenous and intraventricular routes) is recommended. However, during the period of this study, colistimethate sodium or polymyxin B was unavailable in our hospital. And all Acinetobacter baumannii in this study were resistant to meropenem. Combined use of other sensitive antibiotics and high dose carbapenem with prolonged injection may have synergistic a effect.10 But it’s recommended that the carbapenem’s MIC should be less than 16mg/L.11 In this study, we got similar results, the MIC of meropenem was the only statistically significant difference (p = 0.04) in antimicrobial susceptibility testing between the two groups. 50% of Acinetobacter baumannii in the SG (6/12) had meropenem MIC ≤ 16mg/L versus only 22.22% in the FG (2/9). We suggested using other sensitive or intermediate antibiotics instead of carbapenem when treated Acinetobacter baumannii with high MIC. The six survival patients in SG had high dose sulbactam, minocycline and/or levofloxacin, combined with intrathecal amikacin. The relatively high failure rate of treating Acinetobacter baumannii in this study may due to the lack of colistin supply.