Abstract
The polymyxin antibiotics colistin (polymyxin E) and polymyxin B became available in the 1950s and thus did not undergo contemporary drug development procedures. Their clinical use has recently resurged, assuming an important role as salvage therapy for otherwise untreatable gram-negative infections. Since their reintroduction into the clinic, significant confusion remains due to the existence of several different conventions used to describe doses of the polymyxins, differences in their formulations, outdated product information, and uncertainties about susceptibility testing that has led to lack of clarity on how to optimally utilize and dose colistin and polymyxin B. We report consensus therapeutic guidelines for agent selection and dosing of the polymyxin antibiotics for optimal use in adult patients, as endorsed by the American College of Clinical Pharmacy (ACCP), Infectious Diseases Society of America (IDSA), International Society of Anti-Infective Pharmacology (ISAP), Society for Critical Care Medicine (SCCM), and Society of Infectious Diseases Pharmacists (SIDP). The European Society for Clinical Microbiology and Infectious Diseases (ESCMID) endorses this document as a consensus statement. The overall conclusions in the document are endorsed by the European Committee on Antimicrobial Susceptibility Testing (EUCAST). We established a diverse international expert panel to make therapeutic recommendations regarding the pharmacokinetic and pharmacodynamic properties of the drugs and pharmacokinetic targets, polymyxin agent selection, dosing, dosage adjustment and monitoring of colistin and polymyxin B, use of polymyxin-based combination therapy, intrathecal therapy, inhalation therapy, toxicity, and prevention of renal failure. The treatment guidelines provide the first ever consensus recommendations for colistin and polymyxin B therapy that are intended to guide optimal clinical use.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 10-39 |
| Number of pages | 30 |
| Journal | Pharmacotherapy |
| Volume | 39 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 2019 |
Funding
Conflicts of interest: Dr. Giacobbe reports grants from MSD Italia, honoraria from Stepstone Pharma GmbH. Dr. K. Kaye reports grants from Merck and honoraria from Merck, Xellia, Melinta, Allergan, Zavante, and Shionogi. Dr. Li reports honoraria from Genentech. Drs. Li and Nation report grants from NIH together with Qpex Pharmaceuticals. Dr. Mouton reports grants from Basilea, Helperby, Gilead, Polyphor, Adenium, VenatorX, Aicuris, Cidara, Eumedica, Wockhardt, and Nordic-pharma. Dr. Pogue reports grants and honoraria from Merck and personal fees from Allergan, Melinta, Shionogi, Zavante, Tetraphase, and Achaogen. Dr. Tam has a patent #9,820,940 issued. Dr. Tsuji reports grants from Merck and Achaogen. Dr. Viscoli reports personal fees from MSD Int, Gilead, Forrest Italia, Angelini, and Pfizer. Dr. Zavascki reports honoraria from Pfizer, MSD, and CIPLA. All other authors report no conflicts of interest. All authors have submitted the International Committee of Medical Journal Editors Form for Disclosure of Potential Conflicts of Interest. The European Society of Clinical Microbiology and Infectious Diseases (ESCMID) endorses this document as a consensus statement. The overall conclusions in the document are endorsed by the European Committee on Antimicrobial Susceptibility Testing (EUCAST). We acknowledge the important intellectual contribution of the EUCAST/CLSI working group on polymyxins, as a large fraction of the data included in this report are derived from the work of this working group. The panel expresses its gratitude to Keri Sims from ACCP, Michael Rybak from Wayne State University, C. Lindsay DeVane from Pharmacotherapy, Luigia Scudeller and Nancy Gerits from ESCMID, Vita Washington from IDSA, Sylvia Quintanilla from SCCM, Kerry LaPlante and Elizabeth Dodds Ashley from SIDP, and Zackery Bulman and Justin Lenhard from ISAP. We would like to dedicate the guidelines to Dr. Alan Forrest, who was instrumental in shaping the modern-day PK/PD/TD knowledge of the polymyxins.
Keywords
- colistin
- dosing guidelines
- polymyxin B
ASJC Scopus subject areas
- Pharmacology (medical)