Research Journal of Pharmacy and Technology

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Efficacy and Safety of Colistin-imipenem/Cilastatin Combination Therapy for Multidrug-resistant Gram-negative Bacteria Infections in Critically Ill Pediatric Patients


Affiliations
1 Department of Pharmacy Practice, Faculty of Pharmacy, Heliopolis University, Cairo, Egypt
2 Department of Clinical Pharmacy, Faculty of Pharmacy, Ain-Shams University, Cairo,, Egypt
3 Department of Pediatric Surgery, Faculty of Medicine, Ain Shams University, Cairo,, Egypt
     

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Purpose: The aim of this study was to ensure the safety and efficacy of intravenous administration of colistin-imipenem/cilastatin combination to critically ill pediatrics suffering from multidrug-resistant gram-negative sepsis. Patients and methods: The study was designed to give sixty patients in Al-Demerdash hospital pediatric intensive care units (PICU), Ain Shams University, Cairo, Egypt, either imipenem/cilastatin as a monotherapy (thirty patients) or colistin-imipenem/cilastatin intravenously as a combination (thirty patients). The interventional prospective randomized study was performed with focusing on patients' hemodynamic parameters, vital signs, sepsis markers and microbiological response. Results: Thirty patients received intravenous colistin-imipenem/cilastatin combination; with median age of 8.5 months (range: 1-36 months). The isolated bacteria were Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa and Escherichia coli. Klebsiella pneumoniae was the most common isolate (51.7%) of the overall examined sixty patients. Patient who received the combination therapy, was associated with improving in vital signs and hemodynamic parameters with significant p = 0.001, and microbiological responses were represented by the recorded cultures. No patients were defined by renal impairment or neurological toxicity as a side effect to colistin therapy. However, non-significant differences in fatality was found among the two groups with p = 0.108. Conclusion: Colistin combination therapy resulted in better clinical outcomes of PICU patients, which were represented by eradication of the multidrug-resistant gram-negative bacteria without noticeable nephrotoxicity.

Keywords

Imipenem/Cilastatin, Colistin, Pediatrics, Combination therapy, MDR.
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  • Efficacy and Safety of Colistin-imipenem/Cilastatin Combination Therapy for Multidrug-resistant Gram-negative Bacteria Infections in Critically Ill Pediatric Patients

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Authors

Ahmed S. Mancy
Department of Pharmacy Practice, Faculty of Pharmacy, Heliopolis University, Cairo, Egypt
Sara Shaheen
Department of Clinical Pharmacy, Faculty of Pharmacy, Ain-Shams University, Cairo,, Egypt
Ayman Albaghdady
Department of Pediatric Surgery, Faculty of Medicine, Ain Shams University, Cairo,, Egypt
Nagwa A. Sabri
Department of Clinical Pharmacy, Faculty of Pharmacy, Ain-Shams University, Cairo,, Egypt

Abstract


Purpose: The aim of this study was to ensure the safety and efficacy of intravenous administration of colistin-imipenem/cilastatin combination to critically ill pediatrics suffering from multidrug-resistant gram-negative sepsis. Patients and methods: The study was designed to give sixty patients in Al-Demerdash hospital pediatric intensive care units (PICU), Ain Shams University, Cairo, Egypt, either imipenem/cilastatin as a monotherapy (thirty patients) or colistin-imipenem/cilastatin intravenously as a combination (thirty patients). The interventional prospective randomized study was performed with focusing on patients' hemodynamic parameters, vital signs, sepsis markers and microbiological response. Results: Thirty patients received intravenous colistin-imipenem/cilastatin combination; with median age of 8.5 months (range: 1-36 months). The isolated bacteria were Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa and Escherichia coli. Klebsiella pneumoniae was the most common isolate (51.7%) of the overall examined sixty patients. Patient who received the combination therapy, was associated with improving in vital signs and hemodynamic parameters with significant p = 0.001, and microbiological responses were represented by the recorded cultures. No patients were defined by renal impairment or neurological toxicity as a side effect to colistin therapy. However, non-significant differences in fatality was found among the two groups with p = 0.108. Conclusion: Colistin combination therapy resulted in better clinical outcomes of PICU patients, which were represented by eradication of the multidrug-resistant gram-negative bacteria without noticeable nephrotoxicity.

Keywords


Imipenem/Cilastatin, Colistin, Pediatrics, Combination therapy, MDR.

References