title: Colistin administration to pediatric and neonatal patients.
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.
authors.affiliation: 3rd Department of Pediatrics, Aristotle University School of Medicine, Hippokration Hospital, Konstantinoupoleos 49, GR 54642, Thessaloniki, Greece.
authors.forename: Elias
authors.initials: E
authors.lastname: Iosifidis
authors.forename: Charalampos
authors.initials: C
authors.lastname: Antachopoulos
authors.forename: Maria
authors.initials: M
authors.lastname: Ioannidou
authors.forename: Magda
authors.initials: M
authors.lastname: Mitroudi
authors.forename: Maria
authors.initials: M
authors.lastname: Sdougka
authors.forename: Vassiliki
authors.initials: V
authors.lastname: Drossou-Agakidou
authors.forename: Maria
authors.initials: M
authors.lastname: Tsivitanidou
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Roilides
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000336:Aerosols; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003091:Colistin / Q000008:administration & dosage / Q000627:therapeutic use*; D003428:Cross Infection / Q000188:drug therapy* / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D007276:Injections, Intraventricular; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000336:Aerosols; D000900:Anti-Bacterial Agents; D003091:Colistin