Efficacy and Safety of a Colistin Loading Dose, High-Dose Maintenance Regimen in Critically Ill Patients with Multidrug-Resistant Gram-Negative Pneumonia

Jessica L. Elefritz, Karri A. Bauer, Christian Jones, Julie E. Mangino, Kyle Porter, Claire V. Murphy

Research output: Contribution to journalArticle


Introduction: Emergence of multidrug-resistant (MDR) gram-negative (GN) pathogens and lack of novel antibiotics have increased the use of colistin, despite unknown optimal dosing. This study aimed to evaluate the safety and efficacy of a colistin loading dose, high-dose (LDHD) maintenance regimen in patients with MDR-GN pneumonia. Methods: A retrospective cohort analysis was performed comparing critically ill patients with MDR-GN pneumonia pre- and postimplementation of a colistin LDHD guideline with a primary outcome of clinical cure. Safety was assessed using incidence of acute kidney injury (AKI) based on RIFLE (risk, injury, failure, loss, end-stage renal disease) criteria. Results: Seventy-two patients met the inclusion criteria (42 preimplementation and 30 postimplementation). Clinical cure was achieved in 23 (55%) patients in the preimplementation group and 20 (67%) patients in the postimplementation group (P =.31). AKI occurred in 50% of the patients during the preimplementation period and 58% during the postimplementation period (P =.59) with no difference in initiation rates of renal replacement therapy. Conclusion: The increased clinical cure rate after implementation of the colistin LDHD guideline did not reach statistical significance. The LDHD guideline, however, was not associated with an increased incidence of AKI, despite higher intravenous colistin doses. Opportunity exists to optimize colistin dosage while balancing toxicity, but larger studies are warranted.

Original languageEnglish (US)
Pages (from-to)487-493
Number of pages7
JournalJournal of Intensive Care Medicine
Issue number8
Publication statusPublished - Sep 1 2017



  • colistimethate sodium
  • colistin
  • intensive care unit
  • multidrug resistance
  • nephrotoxicity
  • pneumonia

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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