Nebulized colistin linked to fewer adverse events in lower respiratory tract infections

Localized administration of colistin reduces the incidence of systemic adverse events in patients with lower respiratory tract infection (LRTI), a recent study has shown.

“Current literature supports efficacy of nebulized colistin as adjunctive treatment for LRTI,” the authors said. “However, there is a paucity of data surrounding safety of this administration technique.”

In this study, the authors accessed electronic medical records (EMR) to identify patients treated with nebulized colistin between 1 January 2016 and 31 December 2018.

The following data were obtained from the EMR as well as hospital adverse drug reaction (ADR) reporting systems: demographics, dose, serum creatinine, concomitant nephrotoxins, infecting pathogen, treatment-emergent ADRs, and drug toxicities. The prevalence of renal, neurologic, or respiratory ADRs secondary to nebulized colistin was the primary outcome.

Thirty-two patients were administered nebulized colistin in this analysis, of whom about 18 percent had baseline chronic kidney disease. Twenty-nine patients had cultures that turned out positive, of which 11 organisms were resistant to all tested antimicrobial agents.

In addition, three patients had acute kidney injury, one suffered a neurologic reaction, and another developed a respiratory reaction. However, none of these incidents were found to be related to treatment.

These findings suggest that nebulized colistin is a safe adjunct in the management of LRTI.

“Systemic colistin is often utilized for management of drug-resistant LRTI,” the authors said. “Nebulized administration of colistin allows direct instillation of active agent to maximize concentrations and limit systemic toxicities.”