%0 Journal Article %1 Petrosillo2008a %A Petrosillo, N. %A Ioannidou, E. %A Falagas, M. E. %D 2008 %J Clin Microbiol Infect %K colistin %N 9 %P 816--827 %R 10.1111/j.1469-0691.2008.02061.x %T Colistin monotherapy vs. combination therapy: evidence from microbiological, animal and clinical studies. %U http://dx.doi.org/10.1111/j.1469-0691.2008.02061.x %V 14 %X Colistin is commonly the last resort for treatment of infections caused by multidrug-resistant Gram-negative bacteria. In clinical practice, it is frequently used as combination therapy in order to improve its antibacterial activity, despite the consequent increase in toxicity. The available evidence from various studies (microbiological, animal and clinical studies, retrieved from the PubMed and Scopus databases) regarding the comparative effectiveness of colistin monotherapy and colistin combination therapy was evaluated. Most of the microbiological studies examined colistin monotherapy vs. combinations with rifampicin (nine studies) or carbapenems (three studies) for Pseudomonas aeruginosa or Acinetobacter baumannii infections. A synergistic effect was detected in all the studies examining the combination of colistin and rifampicin, whereas carbapenems exhibited a synergistic effect in two of three studies. Most of the animal studies examined colistin monotherapy vs. combinations with rifampicin, carbenicillin, piperacillin and imipenem for treatment of P. aeruginosa, A. baumannii or Escherichia coli infections. Mortality rates were significantly lower in the combination treatment arm in three of six relevant studies. However, data from the small number (four) of relevant human studies suggest non-inferiority of colistin monotherapy as compared with combination therapy. In conclusion, microbiological studies suggest superiority of colistin combination treatment, which is in contrast to preliminary data from studies in humans. Results from animal study data are equivocal. There is an urgent need for appropriately designed and powered clinical trials addressing this apparently controversial situation.

@article{Petrosillo2008a, abstract = {Colistin is commonly the last resort for treatment of infections caused by multidrug-resistant Gram-negative bacteria. In clinical practice, it is frequently used as combination therapy in order to improve its antibacterial activity, despite the consequent increase in toxicity. The available evidence from various studies (microbiological, animal and clinical studies, retrieved from the PubMed and Scopus databases) regarding the comparative effectiveness of colistin monotherapy and colistin combination therapy was evaluated. Most of the microbiological studies examined colistin monotherapy vs. combinations with rifampicin (nine studies) or carbapenems (three studies) for Pseudomonas aeruginosa or Acinetobacter baumannii infections. A synergistic effect was detected in all the studies examining the combination of colistin and rifampicin, whereas carbapenems exhibited a synergistic effect in two of three studies. Most of the animal studies examined colistin monotherapy vs. combinations with rifampicin, carbenicillin, piperacillin and imipenem for treatment of P. aeruginosa, A. baumannii or Escherichia coli infections. Mortality rates were significantly lower in the combination treatment arm in three of six relevant studies. However, data from the small number (four) of relevant human studies suggest non-inferiority of colistin monotherapy as compared with combination therapy. In conclusion, microbiological studies suggest superiority of colistin combination treatment, which is in contrast to preliminary data from studies in humans. Results from animal study data are equivocal. There is an urgent need for appropriately designed and powered clinical trials addressing this apparently controversial situation.}, added-at = {2012-05-30T22:27:17.000+0200}, author = {Petrosillo, N. and Ioannidou, E. and Falagas, M. E.}, biburl = {https://www.bibsonomy.org/bibtex/269b2ef97afd70cf0fcc6f00d684e46b1/aorchid}, description = {In vitro studies suggest comination with rifampin almost always is better than colistin alone, while carbapenem and pipericillin gave inconsistent results. Animal studies support combination therapy, but the four small human studies suggest non-inferiority for colistin alone. Bactericidal activity appears to be dependent upon the concentration of colistin and seems to be only at concentrations >2-4 or when synergistic combination is used.}, doi = {10.1111/j.1469-0691.2008.02061.x}, file = {review of colistin published studies:ID_General/ClinMicrobiolInfect.14.816.pdf:PDF}, groups = {public}, institution = {National Institute for Infectious Diseases L Spallanzani, Rome, Italy.}, interhash = {3d91fc5093222983441571dc5e7ba6e8}, intrahash = {69b2ef97afd70cf0fcc6f00d684e46b1}, journal = {Clin Microbiol Infect}, keywords = {colistin}, language = {eng}, medline-pst = {ppublish}, month = Sep, number = 9, pages = {816--827}, pii = {CLM2061}, pmid = {18844682}, timestamp = {2012-05-30T22:27:17.000+0200}, title = {Colistin monotherapy vs. combination therapy: evidence from microbiological, animal and clinical studies.}, url = {http://dx.doi.org/10.1111/j.1469-0691.2008.02061.x}, username = {aorchid}, volume = 14, year = 2008 }