Letter to the Editor

Colistin-associated Acute Renal Failure: Revisited

Authors: Jian Li, PhD, Craig R. Rayner, PharmD, Roger L. Nation, PhD

Abstract

Daram et al1 recently presented a case report outlining the occurrence of acute renal failure, purported to be caused by “colistin,” in a 57-year-old male. In their letter to the editor,1 the authors cited four papers from the literature spanning the period 1962 to 1971, related to the potential for colistin to cause nephrotoxicity. While we agree with Daram et al in their conclusion that physicians should be aware of the potential toxicities of colistin if it is to be used intravenously,1 we would like to clarify a few important issues raised in their letter to the editor and also refer to more recent literature on its potential to cause nephrotoxicity and on its clinical pharmacology.

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References

1.Daram SR, Gogia S, Bastani B. Colistin-associated acute renal failure: revisited. South Med J2005;98:257–258.
 
2.Conway SP, Etherington C, Munday J, et al. Safety and tolerability of bolus intravenous colistin in acute respiratory exacerbations in adults with cystic fibrosis. Ann Pharmacother 2000;34:1238–1242.
 
3.Li J, Coulthard K, Milne R, et al. Steady-state pharmacokinetics of intravenous colistin methanesulphonate in patients with cystic fibrosis. J. Antimicrob. Chemother 2003;52:987–992.
 
4.Al-Aloul M, Miller H, Alapati S, et al. Renal impairment in cystic fibrosis patients due to repeated intravenous aminoglycoside use. Pediatr Pulmonol 2005;39:15–20.
 
5.Falagas ME, Rizos M, Bliziotis IA, et al. Toxicity after prolonged (more than four weeks) administration of intravenous colistin. BMC Infect Dis 2005;5:1.
 
6.Li J, Nation RL, Milne RW, et al. Evaluation of colistin as an agent against multi-resistant Gram-negative bacteria. Int J Antimicrob Agents 2005;25:11–25.
 
7.Li J, Milne RW, Nation RL, et al. Pharmacokinetics of colistin methanesulphonate and colistin in rats following an intravenous dose of colistin methanesulphonate. J Antimicrob Chemother 2004;53:837–840.
 
8.Li J, Turnidge J, Milne R, et al. In vitro pharmacodynamic properties of colistin and colistin methanesulfonate against Pseudomonas aeruginosa isolates from patients with cystic fibrosis.Antimicrob Agents Chemother 2001;45:781–785.
 
9.Li J, Milne RW, Nation RL, et al. Use of high-performance liquid chromatography to study the pharmacokinetics of colistin sulfate in rats following intravenous administration. Antimicrob Agents Chemother 2003;47:1766–1770.
 
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11.Li J, Milne RW, Nation RL, et al. A simple method for the assay of colistin in human plasma, using pre-column derivatization with 9-fluorenylmethyl chloroformate in solid-phase extraction cartridges and reversed-phase high-performance liquid chromatography. J Chromatogr B Biomed Sci Appl2001;761:167–175.
 
12.Li J, Milne RW, Nation RL, et al. Simple method for assaying colistin methanesulfonate in plasma and urine using high-performance liquid chromatography. Antimicrob Agents Chemother 2002;46:3304–3307.