Pharmacokinetics of inhaled colistin in patients with cystic fibrosis
Open Access
- 5 January 2006
- journal article
- clinical trial
- Published by Oxford University Press (OUP) in Journal of Antimicrobial Chemotherapy
- Vol. 57 (2), 306-311
- https://doi.org/10.1093/jac/dki461
Abstract
Objectives: Inhaled colistin is commonly used in patients with cystic fibrosis (CF), but only limited data are available to define its pharmacokinetic profile. Patients and methods: We performed a multicentre study in 30 CF patients to assess sputum, serum and urine concentrations after a single dose of 2 million units of colistin administered by inhalation. In a subgroup of patients we also compared the efficacy of two different nebulizers for administration of inhaled colistin. Results: Serum concentrations of colistin reached their maximum 1.5 h after inhalation and decreased thereafter. Serum concentrations were well below those previously reported for systemic application in all patients. A mean 4.3 ± 1.3% of the inhaled dose was detected in urine. Elimination characteristics did not differ significantly from those previously reported for systemic application. A positive correlation was found between forced expiratory volume in 1 s (FEV1) in per cent predicted and both AUC and maximal colistin concentrations in serum (Cmax). Maximum sputum concentrations were at least 10 times higher than the MIC breakpoint for Pseudomonas aeruginosa proposed by the British Society for Antimicrobial Chemotherapy. Although sputum drug concentrations decreased after a peak at 1 h, the mean colistin concentrations were still above 4 mg/L after 12 h. No differences were seen in polymyxin E sputum concentrations, for CF patients between the two nebulizer systems. Conclusions: The low systemic and high local concentrations of colistin support the use of inhaled colistin in CF patients infected with P. aeruginosa.Keywords
This publication has 27 references indexed in Scilit:
- Comparison of lung deposition of colomycin using the HaloLite and the Pari LC Plus nebulisers in patients with cystic fibrosisArchives of Disease in Childhood, 2003
- Cystic fibrosisThe Lancet, 2003
- Effect of inhaled tobramycin on early Pseudomonas aeruginosa colonisation in patients with cystic fibrosisThe Lancet, 2001
- Clinical outcome after early Pseudomonas aeruginosa infection in cystic fibrosisThe Journal of Pediatrics, 2001
- Antibiotic therapy against Pseudomonas aeruginosa in cystic fibrosis: a European consensusEuropean Respiratory Journal, 2000
- Intermittent Administration of Inhaled Tobramycin in Patients with Cystic FibrosisNew England Journal of Medicine, 1999
- Mucoid Pseudomonas aeruginosa is a marker of poor survival in cystic fibrosisPediatric Pulmonology, 1992
- Prevention of chronic Pseudomonas aeruginosa colonisation in cystic fibrosis by early treatmentThe Lancet, 1991
- Colistin inhalation therapy in cystic fibrosis patients with chronic Pseudomonas aeruginosa lung infectionJournal of Antimicrobial Chemotherapy, 1987
- NEBULISED COLOMYCIN FOR EARLY PSEUDOMONAS COLONISATION IN CYSTIC FIBROSISThe Lancet, 1985