Challenges of Colistin Use in ICU and Therapeutic Drug Monitoring: A Literature Review

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Publikace nespadá pod Ústav výpočetní techniky, ale pod Lékařskou fakultu. Oficiální stránka publikace je na webu muni.cz.
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RYCHLÍČKOVÁ Jitka KUBICKOVA Vendula SUK Pavel URBANEK Karel

Rok publikování 2023
Druh Článek v odborném periodiku
Časopis / Zdroj Antibiotics-Basel
Fakulta / Pracoviště MU

Lékařská fakulta

Citace
www https://www.mdpi.com/2079-6382/12/3/437
Doi http://dx.doi.org/10.3390/antibiotics12030437
Klíčová slova colistin; quantification methods; drug stability; pharmacokinetics; drug monitoring
Popis The emerging resistance of Gram-negative bacteria is a growing problem worldwide. Together with the financial cost, limited efficacy, and local unavailability of newer antibiotics or their combinations, it has led to the reintroduction of colistin as a therapeutic alternative. Despite its protracted development and availability on the market, there is now a complex maze of questions surrounding colistin with a more or less straightforward relationship to its safety and efficacy. This review aims to offer a way to navigate this maze. We focus on summarizing the available literature regarding the use of colistin in critically ill patients, particularly on stability, pharmacokinetics, methods for determining plasma concentrations, and therapeutic drug monitoring benefits and limitations. Based on these data, we then highlight the main gaps in the available information and help define directions for future research on this drug. The first gap is the lack of data on the stability of intravenous and nebulization solutions at clinically relevant concentrations and under external conditions corresponding to clinical practice. Furthermore, pharmacokinetic-pharmacodynamic parameters should be validated using standardized dosing, including a loading dose. Based on the pharmacokinetic data obtained, a population model for critically ill patients should be developed. Finally, the interference of colistin with extracorporeal methods should be quantified.
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