Monitoring therapeutic colistin concentrations in critically ill patients admitted to a tertiary care hospital
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The purpose of this study was to determine the optimal dosage of colistin according to colistin concentrations and the creatinine clearance rate (CLCR) in 21 critically ill haemodialysis and non-haemodialysis patients with Gram-negative bacterial infections admitted to a tertiary care hospital in India.
Methodology and design
Blood samples were collected from patients after the fourth dose of colistin to measure the trough concentrations of colistin using high-pressure liquid chromatography. Additionally, CLCR was calculated using the Cockcroft-Gault equation, and serum creatinine values were used to assess nephrotoxicity.
The optimum therapeutic range of colistin in plasma was considered to be 5–17 µg/ml. Three haemodialysis patients had high plasma colistin concentrations of 25.27 ± 6.65 µg/ml and three non-haemodialysis patients had high colistin concentrations of 36.56 ± 17.26 µg/ml. Six patients had a CLCR value < 20 ml/min. The dosage of colistin in patients with high colistin plasma concentrations and low CLCR was reviewed.
For this group of patients, based on trough concentrations of colistin, CLCR, and clinician’s clinical experience, a reduction of colistin dosage in haemodialysis patients and non-haemodialysis patients, respectively, was suggested to lower elevated plasma colistin concentrations. This dosage reduction may reduce the signs associated with nephrotoxicity and promote improvements in patient life and colistin-related outcomes.
The authors express their sincere gratitude to Dr. Sivaram Hariharan, Department of Pharmaceutical Chemistry, PSG College of Pharmacy, for English proof reading and editing this research work.
Compliance with ethical standards
The study was carried out in patients admitted for routine treatment who provided consent and after obtaining approval from the PSG Institute of Medical Sciences and Research Institutional Human Ethics Committee (Ref: Project No. 14/460). No remuneration was provided to the patients.
No sources of funding were used to conduct this study or prepare this manuscript.
Conflicts of interest
SMV, SP, JJ, NTS, RH, GV, KS, VS have no conflicts of interest that are directly relevant to the content of this article.
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