Pharmacokinetic evaluation of colistin sodium.
BACKGROUND
Although colistin has recently played a key role in the treatment of nosocomial infections due to multidrug resistant Gram-negative pathogens, there is a lack of clinical studies examining colistin pharmacokinetics (PKs) in humans. This refers to all routes of colistin administration in clinical practice. Colistin PK data are also limited in critically ill patients.


METHODS
Literature search took into account data dealing with colistin PK obtained from animal studies performed during previous decades (1970s, 1980s and 1990s) and from recent human studies performed during the last decade.


RESULTS
Valuable information on pharmacodynamics (PD)/PK of colistin used in the treatments of nosocomial infections due to multidrug resistant Gram-negative pathogens, mostly Pseudomonas aeruginosa, Acinetobacter baumannii and Klebsiella pneumoniae. A better understanding of PKs could offer significant improvement of colistin use in humans, especially optimization of colistin doses in different routes of administration in order to maximize clinical efficacy and minimize adverse effects and rate of resistance.


CONCLUSIONS
There is a lack of human studies on colistin PK and PD. Significant PD parameters best predicting colistin efficacy and their optimal values such as C(max):MIC ratio, AUC/MIC and T > MIC have not yet been clearly defined. It should be noted that further investigation on colistin PK/PD in vitro and in vivo models is required.
Intensive Care Unit, Henry Dunant Hospital, 107 Mesogeion Ave, 11528, Athens, Greece. amichalopoulos@hol.gr
Argyris S
AS
Michalopoulos
Dimitra C
DC
Karatza
Leonidas
L
Gregorakos
D000818:Animals; D000900:Anti-Bacterial Agents / Q000493:pharmacokinetics* / Q000494:pharmacology / Q000627:therapeutic use; D019540:Area Under Curve; D002986:Clinical Trials as Topic; D003091:Colistin / Q000493:pharmacokinetics* / Q000494:pharmacology / Q000627:therapeutic use; D016638:Critical Illness; D003428:Cross Infection / Q000188:drug therapy*; D004353:Drug Evaluation, Preclinical; D024901:Drug Resistance, Multiple, Bacterial; D006090:Gram-Negative Bacteria / Q000187:drug effects; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy; D006801:Humans; D008826:Microbial Sensitivity Tests
D000900:Anti-Bacterial Agents; D003091:Colistin