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Colistin methanesulfonate and colistin pharmacokinetics in critically ill patients receiving continuous venovenous hemodiafiltration
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
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2013 (English)In: Antimicrobial Agents and Chemotherapy, ISSN 0066-4804, E-ISSN 1098-6596, Vol. 57, no 1, 668-671 p.Article in journal (Refereed) Published
Abstract [en]

This report describes the pharmacokinetics of colistin methanesulfonate (CMS) and colistin in five intensive care unit patients receiving continuous venovenous hemodiafiltration. For CMS, the mean maximum concentration of drug in plasma (C(max)) after the fourth dose was 6.92 mg/liter and total clearance (CL) 8.23 liters/h. For colistin, the mean concentration was 0.92 mg/liter and CL/metabolized fraction (f(m)) 18.91 liters/h. Colistin concentrations were below the current MIC breakpoints, and the area under the concentration-time curve for the free, unbound fraction of the drug over 24 h in the steady state divided by the MIC (fAUC/MIC) was lower than recommended, suggesting that a dosage regimen of 160 mg CMS every 8 h (q8h) is inadequate.

Place, publisher, year, edition, pages
2013. Vol. 57, no 1, 668-671 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-189473DOI: 10.1128/AAC.00985-12ISI: 000312958400097PubMedID: 23147733OAI: oai:DiVA.org:uu-189473DiVA: diva2:581563
Available from: 2013-01-02 Created: 2013-01-02 Last updated: 2014-04-11Bibliographically approved
In thesis
1. Optimization of Colistin Dosage in the Treatment of Multiresistant Gram-negative Infections
Open this publication in new window or tab >>Optimization of Colistin Dosage in the Treatment of Multiresistant Gram-negative Infections
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

As multidrug resistance in Gram-negative bacilli increases, the old antibiotic colistin has rapidly gained attention as one of few last line treatment options in the form of colistin methanesulfonate (CMS), which is hydrolyzed to colistin both in vitro and in vivo. There is a dearth of knowledge on fundamental aspects of colistin, including pharmacokinetics and optimal dosing regimens. The aim of this thesis was to improve the basis for optimal colistin therapy.

To be able to study colistin, an LC-MS/MS assay method was developed which is sensitive, specific and useful in both in vivo and in vitro studies. Using this method we detected a significant loss of colistin during standard laboratory procedures. This loss was characterized and quantified, the hypothesis being that the loss is mainly caused by adsorption to labware.

The pharmacokinetics of colistin was studied in two populations of critically ill patients, one with normal renal function and one with renal replacement therapy. Plasma concentrations were assayed with the method above, and population modeling was employed to describe the data. The results include a previously unseen, long elimination half-life of colistin. The data from the population on renal replacement therapy was described without modeling, and showed that both CMS and colistin are cleared by hemodiafiltration.

Combination therapy is an approach that is often used when treating patients infected with multidrug-resistant pathogens. The thesis discusses how the joint effect of antibiotics can be measured using colistin and meropenem as a model, and proposes a method for testing antibiotic combinations. Furthermore, a PKPD model was adapted to describe the pharmacodynamics of the combination.

In conclusion, a specific and sensitive method for analysis of colistin was developed and the adsorption of colistin to materials was described. The assay method has been well accepted internationally. The pharmacokinetics of colistin and CMS was described in two important patient populations, partly with surprising results that have influenced dosages of colistin worldwide. The pharmacodynamics of combination therapy was investigated and quantified, and the methods applied could be further developed into clinically useful tools for selection of antibiotic combinations.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2013. 56 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 889
Colistin, CMS, Pharmacology, Pharmacokinetics, PKPD, Antibiotics, Combination therapy, Pharmacometrics, Dosing regimens, Antibiotic resistance
National Category
Infectious Medicine Pharmacology and Toxicology Microbiology in the medical area
Research subject
Infectious Diseases
urn:nbn:se:uu:diva-197724 (URN)978-91-554-8640-2 (ISBN)
Public defence
2013-05-20, Hörsalen, Klinisk mikrobiologi, Dag Hammarskjölds väg 17, Uppsala, 09:15 (English)
Available from: 2013-04-26 Created: 2013-04-02 Last updated: 2013-08-30Bibliographically approved

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Karvanen, MattiFriberg, Lena ECars, Otto
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