Inhaled colistin monotherapy for respiratory tract infections in adults without cystic fibrosis: a systematic review and meta-analysis.

Abstract

BACKGROUND:

Inhaled colistin is becoming increasingly popular against respiratory tract infections caused by multidrug resistant (MDR) Gram-negative bacteria because it may overcome the problems associated with intravenous (IV) administration.

OBJECTIVE:

To investigate the effectiveness and safety of inhaled colistin as monotherapy (without concomitant IV administration of colistin) in the treatment of respiratory tract infections caused by MDR or colistin-only susceptible Gram-negative bacteria.

METHODS:

PubMed and Scopus databases were searched. A systematic review and meta-analysis were conducted.

RESULTS:

Twelve studies (373 patients receiving inhaled colistin for respiratory tract infection) were included. Ten studies evaluated patients with pneumonia (including 8 studies with ventilator-associated pneumonia) and 2 studies evaluated patients with ventilator-associated tracheobronchitis. Patients with infections due to MDR Acinetobacter baumannii and Pseudomonas aeruginosa were mainly studied. Daily dose of inhaled colistin and treatment duration varied in the individual studies. The pooled all-cause mortality was 33.8% (95% CI 24.6% - 43.6%), clinical success was 70.4% (58.5% - 81.1%) and eradication of Gram-negative bacteria was shown in 71.3% (57.6% - 83.2%) of cases.

CONCLUSIONS:

Inhaled colistin monotherapy may deserve further consideration as a mode for colistin administration for the treatment of respiratory tract infections caused by MDR A. baumannii and P. aeruginosa.

• Authors: Konstantinos Z Vardakas, Georgios L Voulgaris, George Samonis, Matthew E Falagas
• Journal: International journal of antimicrobial agents (Int J Antimicrob Agents) Vol. 51 Issue 1 Pg. 1-9 (Jan 2018) ISSN: 1872-7913 [Electronic] Netherlands
• PMID: 28669836 (Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)
• Copyright: Copyright © 2017 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.

Chemical References

• Anti-Bacterial Agents
• Colistin

Topics

• Acinetobacter Infections (drug therapy, microbiology)
• Acinetobacter baumannii (drug effects, isolation & purification)
• Administration, Inhalation
• Anti-Bacterial Agents (administration & dosage, therapeutic use)
• Colistin (administration & dosage, therapeutic use)
• Drug Resistance, Multiple, Bacterial
• Humans
• Klebsiella Infections (drug therapy, microbiology)
• Klebsiella pneumoniae (drug effects, isolation & purification)
• Nebulizers and Vaporizers
• Pneumonia, Ventilator-Associated (drug therapy, microbiology)
• Pseudomonas Infections (drug therapy, microbiology)
• Pseudomonas aeruginosa (drug effects, isolation & purification)
• Treatment Outcome