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A Randomized Clinical Trial Evaluating the Efficacy of Colistin Loading Dose in Critically Ill Children
OBJECTIVE: Pharmacokinetic and clinical studies recommend applying loading dose of colistin for the treatment of severe infections in the critically ill adults. Pharmacokinetic studies of colistin in children also highlight the need for a loading dose. However, there are no clinical studies evaluati...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer - Medknow
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6952755/ https://www.ncbi.nlm.nih.gov/pubmed/31956632 http://dx.doi.org/10.4103/jrpp.JRPP_19_68 |
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author | Fatehi, Shiva Eshaghi, Hamid Sharifzadeh, Meisam Mirrahimi, Bahador Qorbani, Mostafa Tanzifi, Parin Gholami, Kheirollah Faghihi, Toktam |
author_facet | Fatehi, Shiva Eshaghi, Hamid Sharifzadeh, Meisam Mirrahimi, Bahador Qorbani, Mostafa Tanzifi, Parin Gholami, Kheirollah Faghihi, Toktam |
author_sort | Fatehi, Shiva |
collection | PubMed |
description | OBJECTIVE: Pharmacokinetic and clinical studies recommend applying loading dose of colistin for the treatment of severe infections in the critically ill adults. Pharmacokinetic studies of colistin in children also highlight the need for a loading dose. However, there are no clinical studies evaluating the effectiveness of colistin loading dose in children. METHODS: In a randomized trial, children with ventilator-associated pneumonia or central line-associated bloodstream infection (CLABSI) for whom colistin was initiated, were enrolled. Patients were randomized into two groups; loading dose and conventional dose treatment arms. In the conventional treatment arm, colistimethate sodium was initiated with maintenance dose. In the loading dose group, colistimethate sodium was commenced with a loading dose of 150,000 international unit/kg, then on the maintenance dose. Both treatment arms also received meropenem as combination therapy. Primary outcomes were overall efficacy, clinical improvement and microbiological cure. Secondary outcomes were colistin-induced nephrotoxicity and development of resistance. FINDINGS: Thirty children completed this study. There was a significantly higher overall efficacy in the group received loading dose (42.9 vs. 6.3%, P = 0.031). There weren’t any significant differences in the clinical and microbiological endpoints. In the subgroup of children with CLABSI, results illustrated a trend toward (though statistically nonsignificant) better clinical cure for patients receiving loading dose. CONCLUSION: This preliminary study suggests that colistin loading dose might have some benefits in critically ill children, specifically in children with CLABSI. Further trials are required to elucidate colistin best dosing strategy in critically ill children with severe infections. |
format | Online Article Text |
id | pubmed-6952755 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Wolters Kluwer - Medknow |
record_format | MEDLINE/PubMed |
spelling | pubmed-69527552020-01-17 A Randomized Clinical Trial Evaluating the Efficacy of Colistin Loading Dose in Critically Ill Children Fatehi, Shiva Eshaghi, Hamid Sharifzadeh, Meisam Mirrahimi, Bahador Qorbani, Mostafa Tanzifi, Parin Gholami, Kheirollah Faghihi, Toktam J Res Pharm Pract Original Article OBJECTIVE: Pharmacokinetic and clinical studies recommend applying loading dose of colistin for the treatment of severe infections in the critically ill adults. Pharmacokinetic studies of colistin in children also highlight the need for a loading dose. However, there are no clinical studies evaluating the effectiveness of colistin loading dose in children. METHODS: In a randomized trial, children with ventilator-associated pneumonia or central line-associated bloodstream infection (CLABSI) for whom colistin was initiated, were enrolled. Patients were randomized into two groups; loading dose and conventional dose treatment arms. In the conventional treatment arm, colistimethate sodium was initiated with maintenance dose. In the loading dose group, colistimethate sodium was commenced with a loading dose of 150,000 international unit/kg, then on the maintenance dose. Both treatment arms also received meropenem as combination therapy. Primary outcomes were overall efficacy, clinical improvement and microbiological cure. Secondary outcomes were colistin-induced nephrotoxicity and development of resistance. FINDINGS: Thirty children completed this study. There was a significantly higher overall efficacy in the group received loading dose (42.9 vs. 6.3%, P = 0.031). There weren’t any significant differences in the clinical and microbiological endpoints. In the subgroup of children with CLABSI, results illustrated a trend toward (though statistically nonsignificant) better clinical cure for patients receiving loading dose. CONCLUSION: This preliminary study suggests that colistin loading dose might have some benefits in critically ill children, specifically in children with CLABSI. Further trials are required to elucidate colistin best dosing strategy in critically ill children with severe infections. Wolters Kluwer - Medknow 2019-12-27 /pmc/articles/PMC6952755/ /pubmed/31956632 http://dx.doi.org/10.4103/jrpp.JRPP_19_68 Text en Copyright: © 2019 Journal of Research in Pharmacy Practice http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. |
spellingShingle | Original Article Fatehi, Shiva Eshaghi, Hamid Sharifzadeh, Meisam Mirrahimi, Bahador Qorbani, Mostafa Tanzifi, Parin Gholami, Kheirollah Faghihi, Toktam A Randomized Clinical Trial Evaluating the Efficacy of Colistin Loading Dose in Critically Ill Children |
title | A Randomized Clinical Trial Evaluating the Efficacy of Colistin Loading Dose in Critically Ill Children |
title_full | A Randomized Clinical Trial Evaluating the Efficacy of Colistin Loading Dose in Critically Ill Children |
title_fullStr | A Randomized Clinical Trial Evaluating the Efficacy of Colistin Loading Dose in Critically Ill Children |
title_full_unstemmed | A Randomized Clinical Trial Evaluating the Efficacy of Colistin Loading Dose in Critically Ill Children |
title_short | A Randomized Clinical Trial Evaluating the Efficacy of Colistin Loading Dose in Critically Ill Children |
title_sort | randomized clinical trial evaluating the efficacy of colistin loading dose in critically ill children |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6952755/ https://www.ncbi.nlm.nih.gov/pubmed/31956632 http://dx.doi.org/10.4103/jrpp.JRPP_19_68 |
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