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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
Colistin is a cyclic polypeptide antibiotic derived from Bacillus colistinus; it is composed of polymyxins E1 and E2 (or colistins A, B, and C) which act as detergents on cell membranes. Colistin is less toxic than polymyxin B, but otherwise similar; the methanesulfonate (see Chapter 3.81 Colistimethate) is used orally. Colistin is indicated for the treatment of acute or chronic infections due to sensitive strains of certain gram-negative bacilli, particularly Pseudomonas aeruginosa. In pharmaceutical products, colistin is employed as colistin sulfate (CAS number 1264-72-8, EC number 215-034-3, molecular formula C53H102N16O17S) (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 polymyxins (colistin and polymyxin B) have high incidences of nephrotoxicity with polymyxin B, representing a potentially lower risk. In the case of colistin, doses required to achieve serum concentrations capable of even minimal bacterial kill coincide with serum concentrations known to pre-dispose patients to nephrotoxicity [79,80]. Outside of dose and serum concentrations, risk factors for colistin-induced nephrotoxicity are poorly defined. In general, risk factors for anti-infective-induced nephrotoxicity can also be applied to polymyxins, which include, advanced age, use of concomitant nephrotoxins, and obesity [80]. It is worth noting that polymyxin-induced nephrotoxicity is often reversible, and as such, the benefits of aggressive dosing may outweigh the risks [80].
Inhalational therapies for non-cystic fibrosis bronchiectasis
Published in Anthony J. Hickey, Heidi M. Mansour, Inhalation Aerosols, 2019
Ashvini Damodaran, Dustin R. Fraidenburg, Israel Rubinstein
Developed in the 1940s, colistin is a polymyxin antibiotic and is one of the oldest antibiotics in use. Its use declined significantly after other antibiotic classes were discovered, but it has experienced a recent rise in popularity due to the increase of drug-resistant bacteria and the dearth of novel antibiotics on the market. Colistin is a bactericidal antibiotic that acts by disrupting the cellular membrane through binding of lipopolysaccharide (LPS), and it is also known to neutralize endotoxins. It acts in a concentration-dependent manner mostly against aerobic gram-negative bacilli, but its use has been especially of interest against multidrug-resistant bacteria, namely, P. aeruginosa, Acinetobacter baumanni, Klebsiella pneumoniae, and Stenotrophomonas maltophilia. The two forms of colistin available are colistin sulfate and its prodrug, colisthimetate sodium. The drug’s nephrotoxic effects are the most common side effect seen, though it has also been known to cause neurotoxicity, bronchospasm, and hypersensitivity pneumonitis (38). In its nebulized form, colistin has been shown to reduce exacerbations with good adherence to therapy, improve lung function and quality of life, reduce sputum volume and bacterial load, and generally be well tolerated (39–41).
Colistin-associated Stevens-Johnson syndrome and toxic epidermal necrolysis reactions: a retrospective case-non-case pharmacovigilance study
Published in Expert Opinion on Drug Safety, 2022
Richard Tang, Vrishali L. Lopes, Aisling R. Caffrey
Colistin is a last resort antibiotic with a historically poor safety profile. The antibiotic belongs to the polymyxin class in which each chemical compound is differentiated by their amino acid sequences and fatty acid side chains. The two primary polymyxins used in clinical practice include polymyxin B and polymyxin E (colistin) [11]. Colistin is chiefly effective against strains of gram-negative bacilli such as Pseudomonas aeruginosa, Enterobacter aerogenes, Escherichia coli, and Klebsiella pneumoniae that are resistant to other antibiotics. Off-label indications include a nebulized form of colistin for bronchiectasis in both cystic fibrosis (CF) and non-cystic fibrosis patients and hospital-acquired or ventilator-associated pneumonia [12]. Previous pharmacovigilance studies using the Food and Drug Administration (FDA) Adverse Events Reporting System (FAERS), as well as other health outcome studies, have demonstrated a strong association between colistin and nephrotoxicity, especially with increasing cumulative doses of colistin. Colistin, as well as polymyxin B, have both been reintroduced into the antimicrobial armory as multidrug-resistant bacteria are becoming both more prevalent and difficult to treat [11–14]. Due to the known toxicity of colistin and increased risk of SJS/TEN with other antibiotics [1,3–6], we investigated SJS/TEN reporting rates with colistin utilizing FAERS data in this case-non-case study, a study design used specifically to analyze the disproportionality of drug safety events in pharmacovigilance databases.
Determination of the retinal toxicity of intravitreal colistin in rabbit eyes
Published in Cutaneous and Ocular Toxicology, 2021
Merve Ozbek, Mahmut Odabasi, Sevil Karaman Erdur, Fevzi Senturk, Mustafa Ozsutcu, Cengiz Aras, Mustafa Eliacik
Colistin is used as a last-resort antibiotic for treating infections caused by MDR Gram-negative organisms, such as P. aeruginosa, K. pneumoniae, and A. baumannii [10]. Colistin is administered as an inactive prodrug, colistin methanesulfonate (CMS) [18]. According to the European Committee on Antimicrobial Susceptibility Testing (EUCAST), the susceptibility breakpoints of colistin are ≤ 2 mg/L for Acinetobacter spp. and ≤ 4 mg/L for Pseudomonas spp. [19]. The exact mechanism of action of colistin is unknown, but it has been proposed that its activity is related to disruption of the bacterial inner and outer membranes [20]. CMS is eliminated by the kidneys, but colistin is mainly eliminated by non-renal mechanism(s) that are as of yet not characterised [21]. Following parenteral administration of CMS, colistin is formed slowly, and the plasma concentration increases slowly. This can be managed with the use of a loading dose. It has been reported that at 8 h after the loading dose, the colistin plasma concentration is optimal for the eradication of the infecting bacteria [18]. The estimated half-life of CMS and colistin are 2 and 3 h, respectively [22]. Nephrotoxicity is the dose-limiting and most common side effect associated with parenteral colistin. The majority of nephrotoxicity cases occur after 15 days of therapy [18].
Formulation of chitosan coated nanoliposomes for the oral delivery of colistin sulfate: in vitro characterization, 99mTc-radiolabeling and in vivo biodistribution studies
Published in Drug Development and Industrial Pharmacy, 2021
Mohamed H. Aboumanei, Ashgan. F. Mahmoud, M. A. Motaleb
Many studies have been attempted to improve the delivery and bioavailability of colistin but without significant progress. For example, Wang et al. [30] encapsulated ciprofloxacin and colistin in anionic liposomes. Yu et al. [31] developed colistin co-loaded liposomes using sucrose, leucine, and mannitol as formulations for a dry powder inhaler. Liu et al. [32] prepared nanoparticles of colistin through the complexation of colistin with polyglutamic acid and subsequent stabilization with 1,2-dimyristoyl-sn-glycero-3-phosphoethanolamine-N-[methoxy (polyethylene glycol)-2000] ammonium salt (MW 2700). But, the in vivo and in vitro results showed that colistin nanoparticles had equivalent antimicrobial activity against Klebsiella pneumoniae and Acinetobacter baumanniito that of free colistin [33]. However, to the best of our knowledge, studies on chitosan-coated liposomes as colistin delivery carriers for oral administration have not yet been reported in the literature. Therefore, there is an urgency to provide evidence for the in vitro and in vivo efficiency of chitosan-coated nano-liposomes incorporating colistin for oral delivery.