Skip to main content
Log in

Colistin administration to pediatric and neonatal patients

  • Original Paper
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Emergence of multidrug-resistant Gram-negative nosocomial pathogens has led to resurgence of colistin use. Safety and efficacy data regarding colistin use in pediatric patients are sparse, while optimal dosage has not been defined. We present a case series of neonates and children without cystic fibrosis treated with various doses of colistin intravenously. The records of patients who received colistin in a tertiary-care hospital from January 2007 to March 2009 were reviewed. Thirteen patients (median age 5 years, range 22 days to 14 years) received 19 courses of colistin as treatment of pneumonia, central nervous system infection, bacteremia, or complicated soft tissue infection. The isolated pathogens were Acinetobacter baumannii, Enterobacter cloacae, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia. Daily dose of colistin (colistimethate) ranged between 40,000 and 225,000 IU/kg. Duration of administration ranged from 1 to 133 days. Other antimicrobials were co-administered in 18/19 courses. Increase of serum creatinine in one patient was associated with co-administration of colistin and gentamicin. Sixteen of 19 courses had a favorable outcome, and only two of the three deaths were infection-related. Colistin intravenous administration appears well tolerated even at higher than previously recommended doses and of prolonged duration.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Boucher HW, Talbot GH, Bradley JS et al (2009) Bad bugs, no drugs: no ESKAPE! An update from the Infectious Diseases Society of America. Clin Infect Dis 48:1–12. doi:10.1086/595011

    Article  PubMed  Google Scholar 

  2. Clinical and Laboratory Standards Institute (2009) Performance standards for antimicrobial susceptibility testing: Nineteenth informational supplement. CLSI, Wayne

    Google Scholar 

  3. Dalgic N, Ceylan Y, Sancar M et al (2009) Successful treatment of multidrug-resistant Acinetobacter baumannii ventriculitis with intravenous and intraventricular colistin. Ann Trop Paediatr 29:141–147. doi:10.1179/146532809X440761

    Article  CAS  PubMed  Google Scholar 

  4. Falagas ME, Bliziotis IA, Kasiakou SK et al (2005) Outcome of infections due to pandrug-resistant (PDR) Gram-negative bacteria. BMC Infect Dis 5:24. doi:10.1186/1471-2334-5-24

    Article  PubMed  Google Scholar 

  5. Falagas ME, Kasiakou SK (2005) Colistin: the revival of polymyxins for the management of multidrug-resistant Gram-negative bacterial infections. Clin Infect Dis 40:1333–1341. doi:10.1086/429323

    Article  CAS  PubMed  Google Scholar 

  6. Falagas ME, Kasiakou SK (2006) Toxicity of polymyxins: a systematic review of the evidence from old and recent studies. Crit Care 10:R27. doi:10.1186/cc3995

    Article  PubMed  Google Scholar 

  7. Falagas ME, Rizos M, Bliziotis IA et al (2005) Toxicity after prolonged (more than four weeks) administration of intravenous colistin. BMC Infect Dis 5:1. doi:10.1186/1471-2334-5-1

    Article  PubMed  Google Scholar 

  8. Falagas ME, Sideri G, Vouloumanou EK et al (2009) Intravenous colistimethate (colistin) use in critically ill children without cystic fibrosis. Pediatr Infect Dis J 28:123–127. doi:10.1097/INF.0b013e31818a5dbd

    Article  PubMed  Google Scholar 

  9. Falagas ME, Vouloumanou EK, Rafailidis PI (2009) Systemic colistin use in children without cystic fibrosis: a systematic review of the literature. Int J Antimicrob Agents 33(503):e1–e13. doi:10.1016/j.ijantimicag.2008.10.021

    PubMed  Google Scholar 

  10. Fernandez-Viladrich P, Corbella X et al (1999) Successful treatment of ventriculitis due to carbapenem-resistant Acinetobacter baumannii with intraventricular colistin sulfomethate sodium. Clin Infect Dis 28:916–917. doi:10.1086/517243

    Article  CAS  PubMed  Google Scholar 

  11. Garnacho-Montero J, Ortiz-Leyba C, Jimenez-Jimenez FJ et al (2003) Treatment of multidrug-resistant Acinetobacter baumannii ventilator-associated pneumonia (VAP) with intravenous colistin: a comparison with imipenem-susceptible VAP. Clin Infect Dis 36:1111–1118. doi:10.1086/374337

    Article  CAS  PubMed  Google Scholar 

  12. Garner JS, Jarvis WR, Emori TG et al (1996) CDC definitions for nosocomial infections. In: Olmsted RN, Olmsted RN (eds) APIC infection control and applied epidemiology principles and practice. Mosby, St. Louis, pp A-1–A-20

    Google Scholar 

  13. Giske CG, Monnet DL, Cars O, Carmeli Y, ReAct-Action on Antibiotic Resistance (2008) Clinical and economic impact of common multidrug-resistant Gram-negative bacilli. Antimicrob Agents Chemother 52:813–821. doi:10.1128/AAC.01169-07

    Article  CAS  PubMed  Google Scholar 

  14. Goverman J, Weber JM, Keaney TJ, Sheridan RL (2007) Intravenous colistin for the treatment of multi-drug resistant, Gram-negative infection in the pediatric burn population. J Burn Care Res 28:421–426. doi:10.1097/BCR.0B013E318053D346

    Article  PubMed  Google Scholar 

  15. Gump WC, Walsh JW (2005) Intrathecal colistin for treatment of highly resistant Pseudomonas ventriculitis. Case report and review of the literature. J Neurosurg 102:915–917. doi:10.3171/jns.2005.102.5.0915

    Article  PubMed  Google Scholar 

  16. Isturiz R (2008) Global resistance trends and the potential impact on empirical therapy. Int J Antimicrob Agents 32:S201–S206. doi:10.1016/S0924-8579(09)70003-2

    Article  CAS  PubMed  Google Scholar 

  17. Jimenez-Mejias ME, Pichardo-Guerrero C, Marquez-Rivas FJ et al (2002) Cerebrospinal fluid penetration and pharmacokinetic/pharmacodynamic parameters of intravenously administered colistin in a case of multidrug-resistant Acinetobacter baumannii meningitis. Eur J Clin Microbiol Infect Dis 21:212–214. doi:10.1007/s10096-001-0680-2

    Article  CAS  PubMed  Google Scholar 

  18. Kasiakou SK, Michalopoulos A, Soteriades ES et al (2005) Combination therapy with intravenous colistin for management of infections due to multidrug-resistant Gram-negative bacteria in patients without cystic fibrosis. Antimicrob Agents Chemother 49:3136–3146. doi:10.1128/AAC.49.8.3136-3146.2005

    Article  CAS  PubMed  Google Scholar 

  19. Katragkou A, Roilides E (2005) Successful treatment of multidrug-resistant Acinetobacter baumannii central nervous system infections with colistin. J Clin Microbiol 43:4916–4917. doi:10.1128/JCM.43.9.4916-4917.2005

    Article  PubMed  Google Scholar 

  20. Landman D, Georgescu C, Martin DA, Quale J (2008) Polymyxins revisited. Clin Microbiol Rev 21:449–465. doi:10.1128/CMR.00006-08

    Article  CAS  PubMed  Google Scholar 

  21. Lee SY, Lee JW, Jeong DC et al (2008) Multidrug-Acinetobacter meningitis in a 3-year-old boy treated with i.v. colistin. Pediatr Int 50:584–585. doi:10.1111/j.1442-200X.2008.02677.x

    Article  PubMed  Google Scholar 

  22. Levin AS, Barone AA, Penco J et al (1999) Intravenous colistin as therapy for nosocomial infections caused by multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii. Clin Infect Dis 28:1008–1011. doi:10.1086/514732

    Article  CAS  PubMed  Google Scholar 

  23. Li J (2005) Difficulty in assaying colistin methanesulphonate. Clin Microbiol Infect 11:773–774. doi:10.1111/j.1469-0691.2005.01218.x

    Article  CAS  PubMed  Google Scholar 

  24. Li J, Coulthard K, Milne R, Nation RL et al (2003) Steady-state pharmacokinetics of intravenous colistin methanesulphonate in patients with cystic fibrosis. J Antimicrob Chemother 52:987–992. doi:10.1093/jac/dkg468

    Article  CAS  PubMed  Google Scholar 

  25. Li J, Nation RL, Turnidge JD et al (2006) Colistin: the re-emerging antibiotic for multidrug-resistant Gram-negative bacterial infections. Lancet Infect Dis 6:589–601. doi:10.1016/S1473-3099(06)70580-1

    Article  CAS  PubMed  Google Scholar 

  26. Linden PK, Kusne S, Coley K et al (2003) Use of parenteral colistin for the treatment of serious infection due to antimicrobial-resistant Pseudomonas aeruginosa. Clin Infect Dis 37:e154–e160. doi:10.1086/379611

    Article  CAS  PubMed  Google Scholar 

  27. Markou N, Apostolakos H, Koumoudiou C et al (2003) Intravenous colistin in the treatment of sepsis from multiresistant Gram-negative bacilli in critically ill patients. Crit Care 7:R78–R83. doi:10.1186/cc2358

    Article  PubMed  Google Scholar 

  28. Ng J, Gosbell IB, Kelly JA, Boyle MJ, Ferguson JK (2006) Cure of multiresistant Acinetobacter baumannii central nervous system infections with intraventricular or intrathecal colistin: case series and literature review. J Antimicrob Chemother 58:1078–1081. doi:10.1093/jac/dkl347

    Article  CAS  PubMed  Google Scholar 

  29. Nunn SL, Wellman WE (1960) Pseudomonas meningitis: report of a case. Med Clin North Am 44:1075–1078

    CAS  PubMed  Google Scholar 

  30. Petrosillo N, Ioannidou E, Falagas ME (2008) Colistin monotherapy vs. combination therapy: evidence from microbiological, animal and clinical studies. Clin Microbiol Infect 14:816–827. doi:10.1111/j.1469-0691.2008.02061.x

    Article  CAS  PubMed  Google Scholar 

  31. Pintado V, San Miguel LG, Grill F, Mejia B et al (2008) Intravenous colistin sulphomethate sodium for therapy of infections due to multidrug-resistant Gram-negative bacteria. J Infect 56:185–190. doi:10.1016/j.jinf.2008.01.003

    Article  PubMed  Google Scholar 

  32. Pitout JD (2008) Multiresistant enterobacteriaceae: new threat of an old problem. Expert Rev Anti Infect Ther 6:657–669. doi:10.1586/14787210.6.5.657

    Article  CAS  PubMed  Google Scholar 

  33. Plachouras D, Karvanen M, Friberg LE et al (2009) Population pharmacokinetic analysis of colistin methanesulphonate and colistin after intravenous administration in critically ill patients with infections caused by Gram-negative bacteria. Antimicrob Agents Chemother 53:3430–3436. doi:10.1128/AAC.01361-08

    Article  CAS  PubMed  Google Scholar 

  34. Pournaras S, Protonotariou E, Voulgari E et al (2009) Clonal spread of KPC-2 carbapenemase-producing Klebsiella pneumoniae strains in Greece. J Antimicrob Chemother 64:348–352. doi:10.1093/jac/dkp207

    Article  CAS  PubMed  Google Scholar 

  35. Price DJ, Sleigh JD (1972) Klebsiella meningitis–report of nine cases. J Neurol Neurosurg Psychiatry 35:903–908

    Article  CAS  PubMed  Google Scholar 

  36. Reina R, Estenssoro E, Saenz G et al (2005) Safety and efficacy of colistin in Acinetobacter and Pseudomonas infections: a prospective cohort study. Intensive Care Med 31:1058–1065. doi:10.1007/s00134-005-2691-4

    Article  PubMed  Google Scholar 

  37. Rosanova M, Epelbaum C, Noman A et al (2009) Use of colistin in a pediatric burn unit in Argentina. J Burn Care Res 30:612–615. doi:10.1097/BCR.0b013e3181abffb6

    Article  PubMed  Google Scholar 

  38. Schina M, Spyridi E, Daoudakis M et al (2006) Successful treatment of multidrug-resistant Pseudomonas aeruginosa meningitis with intravenous and intrathecal colistin. Int J Infect Dis 10:178–179. doi:10.1016/j.ijid.2005.03.005

    Article  PubMed  Google Scholar 

  39. Souli M, Galani I, Giamarellou H (2008) Emergence of extensively drug-resistant and pandrug-resistant Gram-negative bacilli in Europe. Euro Surveill 13:19045

    Google Scholar 

  40. Swift PN, Bushby SR (1951) Haemophilus influenza meningitis treated with polymyxin. Lancet 2:183–190

    Article  CAS  PubMed  Google Scholar 

  41. Tamma PD, Lee CK (2009) Use of colistin in children. Pediatr Infect Dis J 28:534–5. doi:10.1097/INF.0b013e3181ac4980

    Article  PubMed  Google Scholar 

  42. Weinbren MJ (1999) Pharmacokinetics of antibiotics in burn patients. J Antimicrob Chemother 44:319–327. doi:10.1093/jac/44.3.319

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

EI was recipient of a research grant from the Hellenic National Institute of Scholarships.

Conflict of interest

None of the authors have any conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Elias Iosifidis.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Iosifidis, E., Antachopoulos, C., Ioannidou, M. et al. Colistin administration to pediatric and neonatal patients. Eur J Pediatr 169, 867–874 (2010). https://doi.org/10.1007/s00431-009-1137-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-009-1137-3

Keywords

Navigation