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1 September 2006 Supplement

Volume 43, Number S2
Clinical Infectious Diseases 2006;43:S89–S94
© 2006 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2006/4305S2-0009$15.00
DOI: 10.1086/504485
SUPPLEMENT ARTICLE

Parenteral and Inhaled Colistin for Treatment of Ventilator‐Associated Pneumonia

Peter K. Linden1 and

David L. Paterson2

1Abdominal Organ Transplant Intensive Care Unit, Department of Critical Care Medicine, and 2Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

The spectrum of available therapeutic options has become drastically narrowed in recent years, particularly for nosocomial multidrug‐resistant gram‐negative pathogens. This therapeutic void has created a resurgence of interest in colistin. In 5 published series since 1999, clinical response rates for pneumonia due to Pseudomonas aeruginosa or Acinetobacter baumannii treated with intravenous colistin have ranged from 25% to 62%, despite high severity of illness at baseline. De novo nephrotoxicity was observed in 8%–36% of patients, despite close attention to both appropriate dosing and duration of treatment. Neurotoxicity, which was commonly described in the old colistin era, has been exceedingly rare in recent experience. Aerosolized therapy as an adjunct to systemic treatment appears promising, but the current published data are much too limited to allow determination of the incremental benefit of the addition of aerosolized treatment to systemic treatment. Colistin is a reasonably safe last‐line therapeutic alternative for pneumonia due to multi‐ or panresistant P. aeruginosa or A. baumannii.

Reprints or correspondence: Dr. Peter K. Linden, Dept. of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15261 ().

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