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Huang X, Liu X, Fan Y, Wang Y, Guo B, Wang J, Yu J, Wei Q, Wu X, Huang H, Zhang J. Pharmacokinetics and safety of colistin sulfate after single and multiple intravenous doses in healthy Chinese subjects. Int J Antimicrob Agents 2024:107326. [PMID: 39276945 DOI: 10.1016/j.ijantimicag.2024.107326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 08/20/2024] [Accepted: 09/02/2024] [Indexed: 09/17/2024]
Abstract
BACKGROUND Increasing antimicrobial resistance has led to the revival of the polymyxins as a last-resort therapeutic option for multidrug-resistant Gram-negative bacterial infections. A parenteral formulation of colistin sulfate is available solely in China. While the onset of action of IV colistin may occur faster than with its prodrug CMS, its pharmacokinetic (PK) profile remains unclear. METHODS This single-centre, open-label, single- and multi-dose, phase 1 trial examined the PKs and safety of colistin sulfate in healthy Chinese adults. Participants received a single 10000 units/kg (equivalent to 0.452 mg/kg) dose of colistin sulfate (single-dose group; n=12) or the same dose q12h for 7 days (multi-dose group, n=12) via a 2-h IV infusion. Colistin concentrations in plasma and urine were determined using LC-MS/MS, and the PK parameters calculated using non-compartmental analysis. RESULTS After a single dose the peak concentration (Cmax), area under the curve from 0 to 12 h (AUC0-12h), terminal half-life (T1/2), volume of distribution (Vd), and total body clearance (CL) of colistin were 1.08 ± 0.18 mg/L, 4.73 ± 0.89 h·mg/L, 3.65 ± 0.55 h, 16.82 ± 2.70 L, and 3.24 ± 0.51 L/h, respectively. No accumulation of colistin was observed after multiple doses. The cumulative urinary recovery of colistin was 0.9 ± 0.7% within 24 h after multi-dose administration. No nephrotoxicity was reported. CONCLUSIONS This study is the first to report colistin PKs in healthy Chinese subjects after single and multiple doses of colistin sulfate. The PK and safety data are required for optimal dose selection in clinical practice.
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Affiliation(s)
- Xiaolan Huang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China; Key Laboratory of Antibiotic Clinical Pharmacology of the National Health Commission, Shanghai, China;; National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaofen Liu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China; Key Laboratory of Antibiotic Clinical Pharmacology of the National Health Commission, Shanghai, China;; National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yaxin Fan
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China; Key Laboratory of Antibiotic Clinical Pharmacology of the National Health Commission, Shanghai, China;; National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yu Wang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China; Key Laboratory of Antibiotic Clinical Pharmacology of the National Health Commission, Shanghai, China;; National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Beining Guo
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China; Key Laboratory of Antibiotic Clinical Pharmacology of the National Health Commission, Shanghai, China;; National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jingjing Wang
- Key Laboratory of Antibiotic Clinical Pharmacology of the National Health Commission, Shanghai, China;; National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China;; Clinical Pharmacology Research Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Jicheng Yu
- Key Laboratory of Antibiotic Clinical Pharmacology of the National Health Commission, Shanghai, China;; National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China;; Clinical Pharmacology Research Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Qiong Wei
- Key Laboratory of Antibiotic Clinical Pharmacology of the National Health Commission, Shanghai, China;; National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China;; Clinical Pharmacology Research Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaojie Wu
- Key Laboratory of Antibiotic Clinical Pharmacology of the National Health Commission, Shanghai, China;; National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China;; Clinical Pharmacology Research Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Haihui Huang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China; Key Laboratory of Antibiotic Clinical Pharmacology of the National Health Commission, Shanghai, China
| | - Jing Zhang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China; Key Laboratory of Antibiotic Clinical Pharmacology of the National Health Commission, Shanghai, China;; National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China;; Clinical Pharmacology Research Center, Huashan Hospital, Fudan University, Shanghai, China; Research Ward of Huashan Hospital, Fudan University, Shanghai, China.
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Deniz M, Alişik M. Risk factors and prognosis for the development of acute kidney injury in patients using colistin in the intensive care unit: A retrospective cohort study. Medicine (Baltimore) 2024; 103:e36913. [PMID: 38215139 PMCID: PMC10783213 DOI: 10.1097/md.0000000000036913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/19/2023] [Indexed: 01/14/2024] Open
Abstract
Colistin, an antibiotic of polymyxin group, has recently been increasingly used in the treatment of multidrug resistant gram-negative bacteria. However, it has serious adverse effects such as acute kidney injury (AKI). We aimed to determine the factors affecting the development of AKI due to colistin, which has serious adverse effects, such as nephrotoxicity and neurotoxicity. We retrospectively analyzed the data of patients who received colistin for multidrug resistant gram-negative sepsis in adult intensive care units between January 2020 and December 2022. Demographic data, blood test results, concomitant drug use, need for renal replacement therapy, and mortality were recorded. Kidney damage was assessed according to the Kidney Disease Improving Global Outcomes criterion. We obtained data from 103 patients, 45 (43.7%) of whom were women. The most common comorbidity was a neurological disorder. Renal damage developed in 59.2% of patients. Renal replacement was required in 50.8% of the patients. Among patients who received colistin, 64.1% died. The use of vasopressors, diuretics, nephrotoxic agents with colistin, advanced age, and hypoalbuminemia were more common in patients with renal injury. Multivariate regression analysis showed that vasopressor use, prior creatinine elevation, and diuretic use were independent risk factors for colistin-induced AKI. Vasoactive agent use, previous kidney injury, and furosemide use were independent risk factors for colistin-induced nephrotoxicity. Considering these factors may be instructive for better monitoring of patients when colistin is required in intensive care units.
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Affiliation(s)
- Mustafa Deniz
- Intensive Care Unit, Izzet Baysal State Hospital, Bolu, Turkey
| | - Murat Alişik
- Medical Biochemistry, Bolu Abant Izzet Baysal University, Bolu, Turkey
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