Pillay-Fuentes Lorente Veshni, Nana Trusha, Black Marianne, Reubenson Gary, Thomas Reenu, Dramowski Angela, Bekker Adrie, du Plessis Nicolette, Demopoulos Despina, Chibabhai Vindana
Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Division of Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
S Afr J Infect Dis. 2025 Aug 5;40(1):730. doi: 10.4102/sajid.v40i1.730. eCollection 2025.
Increasing multidrug-resistant bacterial infections are a global health challenge. Colistin, a polymyxin antimicrobial, has activity against some resistant strains, and despite its adverse effects, it presents a last-line option to treat resistant Gram-negative pathogens. However, paediatric colistin prescribing guidelines are lacking.
To determine paediatric colistin prescribing practices and challenges in South Africa (SA) to aid the development of a paediatric colistin guideline.
We conducted an anonymous online survey of registered medical practitioners in SA who prescribed colistin to patients aged ≤ 14 years in the past 12 months.
Of 196 participants, 71.9% ( = 141/196) completed the survey. Eighty-six respondents ( = 86/146; 58.9%) reported prescribing loading doses (LD), with the median LD and maintenance doses of 150 000 IU/kg/dose (interquartile range (IQR), 75 000-150 000) and 50 000 IU/kg/dose (IQR, 40 000-50 000), respectively. Empiric colistin use was reported by 47.2% ( = 69/146), of whom 46.3% ( = 32/69) continued empiric colistin for ≥ 72 h. Using the Likert scale, respondents highly perceived that therapeutic drug monitoring should be readily available (mean = 3.97). The perception that prescribing colistin should be advised by a microbiologist or infectious disease specialist had a mean score of 2.97, indicating moderate agreement.
This survey demonstrated varied paediatric colistin prescribing practices. Recently, a new evidence-based paediatric guideline for colistin use in SA has been published. A follow-up survey will be conducted to assess the impact of the guideline on paediatric colistin prescribing practices in SA.
This study highlighted paediatric colistin dosing practices in the absence of a paediatric colistin guideline in South Africa.
多重耐药细菌感染日益增加是一项全球卫生挑战。黏菌素是一种多粘菌素类抗菌药物，对一些耐药菌株具有活性，尽管有不良反应，但它是治疗耐药革兰氏阴性病原体的最后一线选择。然而，目前缺乏儿科黏菌素处方指南。
确定南非儿科黏菌素的处方实践和挑战，以协助制定儿科黏菌素指南。
我们对南非过去12个月内向14岁及以下患者开具黏菌素的注册医生进行了一项匿名在线调查。
196名参与者中，71.9%（n = 141/196）完成了调查。86名受访者（n = 86/146；58.9%）报告开具了负荷剂量（LD），LD的中位数和维持剂量分别为150 000 IU/kg/剂量（四分位间距（IQR），75 000 - 150 000）和50 000 IU/kg/剂量（IQR，40 000 - 50 000）。47.2%（n = 69/146）的受访者报告使用经验性黏菌素治疗，其中46.3%（n = 32/69）持续使用经验性黏菌素≥72小时。使用李克特量表，受访者高度认为应随时提供治疗药物监测（平均分为3.97）。认为应由微生物学家或传染病专家建议开具黏菌素的平均分是2.97，表明有中等程度的认同。
本次调查表明儿科黏菌素的处方实践各不相同。最近，南非已发布了一项新的基于证据的儿科黏菌素使用指南。将进行后续调查以评估该指南对南非儿科黏菌素处方实践的影响。
本研究突出了在南非缺乏儿科黏菌素指南的情况下儿科黏菌素的给药实践。
