“Use of Colistin for the treatment of multi drug resistant isolates in neonates”Ejaz Ahmed Khan,1 Shehla Choudhry,1Batool Hussain,2Amna Batool1Department of Pediatrics, Shifa International Hospital,1Islamabad, Aga Khan University Hospital,2 Karachi, Pakistan
BACKGROUND AND AIMS: Experience of using colistin for multi drug resistant organisms (MDRO) in neonates remains limited. We conducted this study to report our experience of using low-dose colistin in neonates with MDRO.
METHODS: It is a retrospective study at neonatal intensive care unit (NICU) of Shifa International Hospital (SIH), Islamabad, Pakistan. The hospital records of neonates admitted from January 2009-October 2011 were reviewed. Neonates who received colistin were analyzed for risk factors (mechanical ventilation, prolonged antibiotics, central venous catheter insertion, surgery), demographics, tolerability and side effects of colistin (fever, rash, seizures, nephrotoxicity and bronchospasm) and outcome.
RESULTS: Thirty neonates (2.8% of admissions) received colistin. Results are shown in Tables 1 and 2 (below)
Table 1. Demographics and Risk Factors for MDRO
Total who received Colistin
< 37 Weeks
≥ 2 Risk Factors
Central Venous Catheter
Common MDRO isolates
•Cephalosporins, Aminoglycosides and Carbapenems
Table 2. Treatment and Outcome
Dose of Colistin
•Inhaled 250,000 units/day
•Intravenous 25,000 units/kg/day
Indications of Colistin Administration
Routes of Treatment
•Inhaled + Intravenous Colistin
•Inhaled Colistin Only
•Intravenous Colistin only
Side effects of Colistin
★No difference of mortality between routes of administration (p=0.24)
Conclusions: Low-dose colistin therapy is well tolerated in neonates for treatment of MDRO.
Key words: Colistin, Multi drug resistant organisms, Neonatal Infections, Colonization, Drug side effects