Inhaled Colistimethate Sodium in the Management of Patients with Bronchiectasis Infected by Pseudomonas aeruginosa : A Narrative Review of Current Evidence
de la Rosa Carrillo, David (Institut d'Investigació Biomèdica Sant Pau)
Suárez-Cuartín, G. (CIBER de Enfermedades Respiratorias. ISCIII)
Golpe, Rafael (Hospital Universitario Lucus Augusti (Lugo))
Martinez-Garcia, M.A. (Hospital Universitario Lucus Augusti (Lugo))
Maíz Carro, Luis (Hospital Universitario Ramón y Cajal (Madrid))

Data:	2022
Resum:	International guidelines on the treatment of bronchiectasis indicate that the use of inhaled antibiotics is effective, especially in symptomatic chronic bronchial infection (CBI) due to Pseudomonas aeruginosa (PA). To date, however, no such treatment has been approved by regulatory agencies. Of the inhaled antibiotics on the market, colistimethate sodium (colistin) is one of the most used in many countries, either in its nebulized presentation or as dry powder. Among the characteristics of this antibiotic, it is worth noting that its main target is the lipopolysaccharide in the outer membrane of the cell wall of gram-negative bacteria and that it has a low rate of resistance to PA (<1%). Most observational studies have shown that the use of colistin in patients with bronchiectasis and CBI due to PA results in a decrease in both the number and severity of exacerbations, an improvement in quality of life, a decrease in sputum volume and purulence, and a high rate of PA eradication, although there are no clear differences with respect to other inhaled antibiotics. However, the lack of randomized clinical trials (RCT) with positive results for its main variable (exacerbations) in an intention-to-treat analysis has prevented its approval by regulatory agencies as a formal indication for use in bronchiectasis. The PROMIS program, made up of two RCT with identical methodology, is currently underway. The first of these RCT (already concluded) has demonstrated a clearly positive effect on the group randomized to colistin in its main variable (number of annual exacerbations), while the results of the second are still pending. This review presents exhaustive information on the pharmacological and microbiological characteristics of colistin, the results of the studies carried out to date, and the future challenges associated with this treatment.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article de revisió ; recerca ; Versió publicada
Matèria:	Colistin ; Nebulized antibiotics ; Pharmacology ; Chronic bronchial infection ; COPD
Publicat a:	Infection and drug resistance, Vol. 15 (2022) , p. 7271-7292, ISSN 1178-6973

DOI: 10.2147/IDR.S318173
PMID: 36540105

22 p, 761.8 KB

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