Indian Journal of Critical Care Medicine Medknow Publications on behalf of the Indian Society of Critical Care Medicine ISSN: 0972-5229 EISSN: 1998-359x Vol. 14, Num. 3, 2010, pp. 161-162

Indian Journal of Critical Care Medicine, Vol. 14, No. 3, July-September, 2010, pp. 161-162

Letter to the Editor

Management with colistin

Harkirat Singh

All India Institute of Medical Sciences, New Delhi, India

Correspondence Address: Harkirat Singh, 1/23 Gents Hostel, AIIMS, New Delhi 29, India, harkirat.aiims@gmail.com

Code Number: cm10035

DOI: 10.4103/0972-5229.74179

Dear Sir,

I read the article "Colistin and polymyxin B: A re-emergence" ^[1] with great interest. I heartily applaud the efforts of the authors to write this review article. However, I would like to add some more information in this regard.

Notably, Proteus spp., Moraxella catarrhalis, Providencia spp., Serratia marcescens, Morganella morganii, gram-negative cocci, and all gram-positive bacteria are resistant to colistin. Moreover, Prevotella and Fusobacterium spp. have variable sensitivity. ^[2] Hence, we should be careful using it against these bacteria.

Aerosolization of colistin into the airway can be complicated by bronchospasm, especially in patients with advanced lung disease and low baseline spirometry; bronchodilation prior to administration may be beneficial. ^[3] In addition, the prodrug colistimethate sodium should be reconstituted just before administration as nebulization so as to avoid excessive conversion to biologically active colistin, which can cause fatal airway or alveolar injury. In patients with pre-existing renal disease, dosage adjustments are required as impaired renal function may increase the risk for respiratory arrest.

Some more neurologic manifestations include psychosis, coma, convulsions, ptosis, diplopia, areflexia, dysphagia, and dysphonia. ^[4],[5] Neuromuscular blockade is because of non-competitive blockade and thus it should not be used simultaneously with neuromuscular blocking agents. Capreomycin may also enhance this effect of colistin.

Prolonged use can cause fungal or bacterial superinfection, including C. difficile-associated diarrhea and pseudomembranous colitis; generally observed in more than 2 months postantibiotic treatment.

References

1.	Gupta S, Govil D, Kakar PN, Prakash O, Arora D, Das S, et al. Colistin and polymyxin B: A re-emergence. Indian J Crit Care Med 2009;13:49-53.  Back to cited text no. 1  [PUBMED]
2.	Li J, Nation RL, Milne RW, Turnidge JD, Coulthard K. Evaluation of colistin as an agent against multi-resistant Gram-negative bacteria. Int J Antimicrob Agents 2005;25:11-25.  Back to cited text no. 2
3.	Beringer P. The clinical use of colistin in patients with cystic fibrosis. Curr Opin Pulm Med 2001;7:434-40.  Back to cited text no. 3
4.	Wolinsky, E, Hines, JD. Neurotoxic and nephrotoxic effects of colistin patients with renal disease. N Engl J Med 1962;266:759-62.  Back to cited text no. 4
5.	Lindesmith LA, Baines RD Jr, Bigelow DB, Petty TL. Reversible respiratory paralysis associated with polymyxin therapy. Ann Intern Med 1968;68:318-27.  Back to cited text no. 5

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