Menna Pierantonio, Salvatorelli Emanuela, Mattei Alessia, Cappiello Dario, Minotti Giorgio, Carassiti Massimiliano
Clinical Pharmacology Unit, University Hospital Campus Bio-Medico of Rome, Rome, Italy.
Chemotherapy. 2018;63(1):35-38. doi: 10.1159/000484974. Epub 2017 Dec 22.
Colistin is a last resort antibiotic to treat multidrug-resistant Gram-negative bacteria infections. Colistin is administered intravenously in the form of its inactive prodrug colistin methanesulfonate (CMS). For patients with acute kidney impairment and continuous renal replacement therapy high extracorporeal clearance may cause a substantial removal of active colistin from the bloodstream, eventually decreasing its antibacterial efficacy. Currently recommended doses of CMS may therefore be inadequate for these patients. We report on the potential value of a modified regimen that adopts a loading dose of CMS (bolus of 9 MU vs. conventional 3 MU every 8 h), followed by maintenance (3 MU every 8 h). Preliminary pharmacokinetic evidence for the feasibility and efficacy of this regimen is described for 2 patients.
黏菌素是治疗多重耐药革兰氏阴性菌感染的一种最后手段的抗生素。黏菌素以其无活性前体药物黏菌素甲磺酸盐（CMS）的形式静脉给药。对于急性肾损伤且接受持续肾脏替代治疗的患者，高体外清除率可能会导致活性黏菌素从血液中大量清除，最终降低其抗菌疗效。因此，目前推荐的CMS剂量可能对这些患者不足。我们报告了一种改良方案的潜在价值，该方案采用CMS负荷剂量（推注9 MU，而不是常规的每8小时3 MU），随后进行维持治疗（每8小时3 MU）。描述了2例患者该方案可行性和疗效的初步药代动力学证据。
