Safety and effectiveness of colistin compared with non-colistin combinations in the treatment of multi drug resistant bacterial infections

Vineeth Salloju, Sahithi Venapally, Nandan Putti, Annie Priyanka


Background: Multi drug resistant (MDR) bacteria are usually defined as when it is resistant to three or more group of antibiotics. The objective of this study was to determine the efficacy and safety of colistin when compared with other antibiotics for the treatment of infections caused by MDR Acinetobacter baumannii and Pseudomonas aeruginosa.

Methods: A single centre, prospective cohort study was conducted at Krishna Institute of medical Sciences, Hyderabad, India between September 2016 to March 2017. Seventy-four patients (74) were included in the study. Primary outcome were good clinical response and thirty days’ mortality, secondary outcome were microbiological response and adverse drug reactions of the drug.

Results: A total of 74 patients were enrolled into the study. Forty patients (40) were received intravenous colistin dose of 2.5mg-5mg/kg/day. Remaining thirty-four patients (34) received other antibiotics which includes carbapenem, aminoglycosides. etc. The mean age, gender, underlying conditions and severity of illness of the patients in both groups were significantly same. In colistin group 27 (67.5%) patients and 11 (32.3%) patients had good clinical response. The overall mortality of the patients in the colistin group was 17.5% and that in the non-colistin group was 38.2%. The incidence of nephrotoxicity in colistin was 15% and 35.2% in non colistin group. No neurotoxicity was observed in present study.

Conclusions: Our study concludes treatment with colistin decreases patient mortality and increase the clinical response in multidrug-resistant A. baumannii and P. aeruginosa infected patients. However large multicentric clinical trials are needed to demonstrate the safety and efficacy of colistin.


Acinetobacter baumannii, Colistin, Multi drug resistant, Nephrotoxicity, Pseudomonas aeruginosa

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Anna S. Levin, Antonio A, Intravenous Colistin as Therapy for Nosocomial Infections Caused by Multidrug- Resistant Pseudomonas aeruginosa and Acinetobacter baumannii, Clinical Infectious Diseases. 1999;28:1008-11.

Rosso-Fernández C. Safety and efficacy of colistin versus meropenem in the empirical treatment of ventilator-associated pneumonia as part of a macro-project funded by the Seventh Framework Program of the European Commission studying off-patent antibiotics: study protocol for a randomized Controlled trial, Biomed Central. 2015;16(102):1-11.

Bing F, Guan J, Wang X, Cong Y, Activity of Colistin in Combination with Meropenem, Tigecycline, Fosfomycin, Fusidic Acid, Rifampin or Sulbactam against Extensively Drug-Resistant Acinetobacter baumannii in a Murine Thigh-Infection Model. PLoS One. 2016;11(6):1-12.

Preetham K. Safety and Efficacy of Intravenous Colistin in Children, Indian Pediatrics. 2015;52(15):129-30.

Markou N, Apostolakos H, Koumoudiou C, Athanasiou M, Koutsoukou A, Alamanos I. Intravenous colistin in the treatment of sepsis from multi resistant Gram-negative bacilli in critically ill patients. Crit Care. 2003;7:78-83.

Ouderkirk JP, Nord JA, Turett GS, Kislak JW. Polymyxin B nephrotoxicity and efficacy against nosocomial infections caused by multi resistant Gram-negative bacteria. Antimicrob Agents Chemother. 2003;47:2659-62.

Spapen. Renal and neurological side effects of colistin in critically ill patients, Annals of Intensive Care. 2011;1-14.

Jason M. Pogue. Incidence of and Risk Factors for Colistin- Associated Nephrotoxicity in a Large Academic Health System, CID. 2011;53:879-84.

Flanagan AD, Adverse effects of sodium colistimethate. Ann Intern Med. 1971;74:143-4.

Yow EM, Tan E, Shane L, Schonfeld S, Abu-Nassar H. Colistin (colymycin) in resistant bacterial infections. A clinical appraisal. Arch Intern Med. 1961;108:664-70.

Koomanachai P, Tiengrim S. Efficacy and safety of colistin (colistimethate sodium) for therapy of infections caused by multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii in Siriraj Hospital, Bangkok, Thailand, International Journal of Infectious Diseases. 2007;11:402-6.

Falagas M, Fragoulis K, Kasiakou S, Sermaidis G, Michalopoulos A. Nephrotoxicity of intravenous colistin: a prospective evaluation. Int J Antimicrob Agents. 2005;26:504-7.

Markou N, Apostolakos H, Koumoudiou C, Athanasiou M, Koutsoukou A, Alamanos I, et al. Intravenous colistin in the treatment of sepsis from multi resistant Gram-negative bacilli in critically ill patients, Critical Care. 2003;7:78-83.