Colistin: the re-emerging antibiotic for multidrug-resistant Gram-negative bacterial infections.
Increasing multidrug resistance in Gram-negative bacteria, in particular Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae, presents a critical problem. Limited therapeutic options have forced infectious disease clinicians and microbiologists to reappraise the clinical application of colistin, a polymyxin antibiotic discovered more than 50 years ago. We summarise recent progress in understanding the complex chemistry, pharmacokinetics, and pharmacodynamics of colistin, the interplay between these three aspects, and their effect on the clinical use of this important antibiotic. Recent clinical findings are reviewed, focusing on evaluation of efficacy, emerging resistance, potential toxicities, and combination therapy. In the battle against rapidly emerging bacterial resistance we can no longer rely entirely on the discovery of new antibiotics; we must also pursue rational approaches to the use of older antibiotics such as colistin.
Li
Jian
J
Facility for Anti-infective Drug Development and Innovation, Victorian College of Pharmacy, Monash University, Parkville, Victoria, Australia. Jian.Li@vcp.monash.edu.au
Nation
Roger L
RL
Turnidge
John D
JD
Milne
Robert W
RW
Coulthard
Kingsley
K
Rayner
Craig R
CR
Paterson
David L
DL
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003091:Colistin / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D018432:Drug Resistance, Multiple; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy*; D006801:Humans
D000900:Anti-Bacterial Agents; D003091:Colistin