Adverse Reactions to Antibiotics in the Critical Care Unit
Cheston B. Cunha, Burke A. Cunha in Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
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].
Antibiotic Use in Farm Animals
Joyce D’Silva, John Webster in The Meat Crisis, 2017
But why all the concern about colistin resistance? After all, colistin is very toxic to people’s kidneys, and is therefore best avoided as a treatment option in most cases. And for many years this is what happened: although colistin had been licensed in 1959, doctors usually did not use it because far better, and less dangerous, antibiotics were available. Unfortunately, as the better antibiotics were used, and overused, in both human and veterinary medicine, resistance to these antibiotics increased. Worse still, for bacteria like E. coli, there had been no discoveries of genuinely new antibiotics in over 30 years.
Monographs of Topical Drugs that Have Caused Contact Allergy/Allergic Contact Dermatitis
Anton C. de Groot in 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).
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].
Safety considerations of current drug treatment strategies for nosocomial pneumonia
Published in Expert Opinion on Drug Safety, 2021
Adrian Ceccato, Pierluigi Di Giannatale, Stefano Nogas, Antoni Torres
The main side effect of colistin is nephrotoxicity, with a prevalence of 20%–76% during treatment. Although the mechanism of nephrotoxicity is unknown, it is known to be dose-dependent, and reversibly [60,61]. High body mass index and higher dose adjusted for body weight have been associated with a higher incidence of nephrotoxicity [62–64]. Colistin is also associated with neurotoxicity, typically presenting with paresthesia, and has an incidence of approximately 7%. Neurotoxicity may also present with visual disturbances, vertigo, mental confusion, ataxia, and seizure. The most severe presentation is a myasthenia-like syndrome with respiratory muscles paralysis [65]. This may present similarly to critical illness polymyoneuropathy, so care must be taken to avoid misdiagnosis.
Synergistic activities of ceftazidime-avibactam in combination with different antibiotics against colistin-nonsusceptible clinical strains of Pseudomonas aeruginosa
Published in Infectious Diseases, 2020
Emel Mataraci Kara, Mesut Yilmaz, Ayşe İstanbullu Tosun, Berna Özbek Çelik
Although colistin monotherapy displays rapid and extensive killing in vitro against MDR gram-negative bacteria, rapid regrowth and the emergence of resistance in vitro and in patients is concerning [14,15]. On the other hand, increasing the daily dose of colistin monotherapy is not a viable option to maximize bacterial killing and minimize the emergence of resistance in patients due to nephrotoxicity. While colistin combination therapies are an option, there are substantial gaps in the knowledge of how to optimise such combinations. Recently, several in vitro studies suggested synergy for polymyxin combinations, including colistin combined with a carbapenem [16,17]. In our study, we could see the synergistic and bactericidal effects of the ceftazidime-avibactam and colistin combination against studied colistin-nonsusceptible strains just at the 1 and 4 xMIC levels, which was sustained for 24 h, except one isolate which was carrying blaIMP (Figure 1(E,F)). This has very promising implications in terms of using lower doses of colistin in therapy, thus lowering its potentially toxic effects. This also holds true for the colistin-resistant isolate (PA-1 and PA-2, which are carrying blaOXA-48), showing important implications for the combinations in the treatment of colistin-resistant strains. Our results, similar to Tängdén et al. [18], showed a synergistic activity colistin plus meropenem against P. aeruginosa isolates.
Related Knowledge Centers
- Acinetobacter
- Antibiotic
- Intramuscular Injection
- Klebsiella Pneumoniae
- Pneumonia
- Prodrug
- Pseudomonas Aeruginosa
- Drug of Last Resort
- Pathogenic Bacteria
- Intravenous Therapy