Letter to the Editor

Colistin-associated Acute Renal Failure: Revisited

Authors: Sumanth R. Daram, MD, Sudhanshu Gogia, MD, Bahar Bastani, MD

Abstract

Sodium colistimethate (colistin) is a parenterally administered polymyxin antibiotic that acts by disrupting bacterial cell membranes. It has been primarily used in the treatment of life-threatening infections caused by multidrug-resistant Gram-negative bacteria, particularlyPseudomonas aeruginosa. The drug has a very narrow therapeutic ratio, with neurotoxicity and nephrotoxicity being the limiting factors. Nephrotoxicity has been reported in 20% of 317 courses of colistin therapy.1 An additional 14 cases of colistin-associated acute renal failure have also been reported before 1974. The risk of nephrotoxicity increases in the setting of preexisting renal dysfunction2,3 and with increasing doses.4 Serum levels and toxicity appear to be a function of the glomerular filtration rate.3

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References

1. Koch-Weser J, Sidel VW, Federman EB, et al. Adverse effects of sodium colistimethate: manifestations and specific reaction rates during 317 courses of therapy. Ann Intern Med 1970;72:857–868.
 
2. Adler S, Segel DP. Nonoliguric renal failure secondary to sodium colistimethate: a report of four cases. Am J Med Sci 1971;262:109–114.
 
3. Elwood CM, Lucas GD, Muehrcke RC. Acute renal failure associated with sodium colistimethate treatment. Arch Intern Med 1966;118:326–334.
 
4. Woolinsky E, Hines JD. Neurotoxic and nephrotoxic effects of colistin in patients with renal disease.N Engl J Med 1962;266:759–762.
 
5. Craig WA, Kunin CM. Significance of serum protein and tissue binding of antimicrobial agents. Annu Rev Med 1976;27:287–300.