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A review on colistin nephrotoxicity

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European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Purpose

Colistin is an antibiotic that was introduced many years ago and was withdrawn because of its nephrotoxicity. Nowadays, reemergence of this antibiotic for multi-drug resistant Gram-negative infections, and a new high dosing regimen recommendation increases concern about its nephrotoxicity. This review attempts to give a view on colistin nephrotoxicity, its prevalence especially in high doses, the mechanism of injury, risk factors, and prevention of this kidney injury.

Method

The data collection was done in PubMed, Scopus and Cochrane databases. The keywords for search terms were “colistin”, “nephrotoxicity”, “toxicity”, “renal failure”, “high dose”, and “risk factor”. Randomized clinical trials and prospective or retrospective observational animal and human studies were included. In all, 60 articles have been reviewed.

Result and conclusion

Colistin is a nephrotoxic antibiotic; a worldwide increase in nosocomial infections has led to an increase in its usage. Nephrotoxicity is the concerning adverse effect of this drug. The mechanism of nephrotoxicity is via an increase in tubular epithelial cell membrane permeability, which results in cation, anion and water influx leading to cell swelling and cell lysis. There are also some oxidative and inflammatory pathways that seem to be involved in colistin nephrotoxicity. Risk factors of colistin nephrotoxicity can be categorized as dose and duration of colistin therapy, co-administration of other nephrotoxic drugs, and patient-related factors such as age, sex, hypoalbuminemia, hyperbilirubinemia, underlying disease and severity of patient illness.

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Authors and Affiliations

  1. Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Niyayesh Cross Road, Valiasr Street, Tehran, Iran

    Atefeh Ordooei Javan & Zahra Sahraei

  2. Department of Infectious Disease, Loghman Hospital, Shahid Beheshti University of Medical Sciences, Lashkar Intersection, Kargar Street, Tehran, Iran

    Shervin Shokouhi

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  1. Atefeh Ordooei Javan
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Correspondence to Zahra Sahraei.

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Ordooei Javan, A., Shokouhi, S. & Sahraei, Z. A review on colistin nephrotoxicity. Eur J Clin Pharmacol 71, 801–810 (2015). https://doi.org/10.1007/s00228-015-1865-4

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