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Indian Journal of Medical Microbiology
Medknow Publications on behalf of Indian Association of Medical Microbiology
ISSN: 0255-0857
EISSN: 0255-0857
Vol. 29, No. 3, 2011, pp. 230-242
Bioline Code: mb11059
Full paper language: English
Document type: Review Article
Document available free of charge

Indian Journal of Medical Microbiology, Vol. 29, No. 3, 2011, pp. 230-242

 en Polymyxins: Antimicrobial susceptibility concerns and therapeutic options
Balaji, V; Jeremiah, S S. & Baliga, P R.

Abstract

The increasing prevalence of multidrug-resistant nosocomial pathogens such as Acinetobacter baumannii check for this species in other resources , Pseudomonas aeruginosa check for this species in other resources and Klebsiella pneumoniae check for this species in other resources poses a great challenge to the treating physicians. The paucity of newer effective antimicrobials has led to renewed interest in the polymyxin group of drugs, as a last resort for treatment of gram-negative bacterial infections. There is a dearth of information on the pharmacological properties of colistin, leading to difficulties in selecting the right dose, dosing interval, and route of administration for treatment, especially in critically-ill patients. The increasing use of colistin over the last few years necessitates the need for accurate and reliable in vitro susceptibility testing methods. Development of heteroresistant strains as a result of colistin monotherapy is also a growing concern. There is a compelling need from the clinicians to provide options for probable and possible colistin combination therapy for multidrug-resistant bacterial infections in the ICU setting. Newer combination drug synergy determination tests are being developed and reported. There are no standardized recommendations from antimicrobial susceptibility testing reference agencies for the testing and interpretation of these drug combinations. Comparison and analysis of these reported methodologies may help to understand and assist the microbiologist to choose the best method that produces accurate results at the earliest. This will help clinicians to select the appropriate combination therapy. In this era of multidrug resistance it is important for the microbiology laboratory to be prepared, by default, to provide timely synergistic susceptibility results in addition to routine susceptibility, if warranted. Not as a favour or at request, but as a responsibility.

Keywords
Colistin, heteroresistance, in vitro susceptibility, monotherapy, synergy testing

 
© Copyright 2011 Indian Journal of Medical Microbiology.
Alternative site location: http://www.ijmm.org

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