The Multidrug-Resistant Gram-negative Superbug Threat Requires Intelligent Use of the Last Weapon
- Author:
Zakuan Zainy Deris
- Publication Type:Editorial
- Keywords:
Gram-negative;
Acinetobacter baumannii;
Klebsiella pneumoniae;
polymyxin B;
colistin
- From:Malaysian Journal of Medical Sciences
2015;22(5):1-6
- CountryMalaysia
- Language:English
-
Abstract:
The global emergence and dissemination of multidrug-resistant Gram-negative superbugs,
particularly carbapenem-resistant Acinetobacter baumannii and Klebsiella pneumoniae, lead to
the limited effectiveness of antibiotics for treating nosocomial infections. In most cases, polymyxins
are the last resort therapy, and these antibiotics must be used intelligently to prolong their efficacy
in clinical practice. Polymyxin B and colistin (polymyxin E) were introduced prior to modern drug
regulation, and the majority of the ‘old’ drug information is unreliable. Recent pharmacokinetic
data do not support the renal dose adjustment of intravenous (IV) polymyxin B as suggested by
the manufacturer, and this drug must be scaled by the total body weight. Whereas IV colistin is
formulated as an inactive prodrug, colistin methanesulfonate (CMS) has different pharmacokinetic
profiles than polymyxin B. To achieve maximum efficacy, CMS should be administered as a loading
dose scaled to body weight and a maintenance dose according to the renal profiles. Polymyxin
combination therapy is suggested due to a sub-therapeutic plasma concentration in a significant
proportion of patients and a high incidence of polymyxin hetero-resistance among Gram-negative
superbugs. In conclusion, polymyxins must be reserved as a last resort and should be wisely used
when truly indicated
- Full text:P020150904549808713121.pdf
