Framework for optimisation of the clinical use of colistin and polymyxin B: the Prato polymyxin consensus

Nation, Roger L., Li, Jian, Cars, Otto, Couet, William, Dudley, Michael N., Kaye, Keith S., Mouton, Johan W., Paterson, David L., Tam, Vincent H., Theuretzbacher, Ursula, Tsuji, Brian T. and Turnidge, John D. (2015) Framework for optimisation of the clinical use of colistin and polymyxin B: the Prato polymyxin consensus. The Lancet Infectious Diseases, 15 2: 225-234. doi:10.1016/S1473-3099(14)70850-3


Author Nation, Roger L.
Li, Jian
Cars, Otto
Couet, William
Dudley, Michael N.
Kaye, Keith S.
Mouton, Johan W.
Paterson, David L.
Tam, Vincent H.
Theuretzbacher, Ursula
Tsuji, Brian T.
Turnidge, John D.
Title Framework for optimisation of the clinical use of colistin and polymyxin B: the Prato polymyxin consensus
Journal name The Lancet Infectious Diseases   Check publisher's open access policy
ISSN 1474-4457
1473-3099
Publication date 2015-02-01
Year available 2014
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1016/S1473-3099(14)70850-3
Volume 15
Issue 2
Start page 225
End page 234
Total pages 10
Place of publication London, United Kingdom
Publisher The Lancet Publishing Group
Collection year 2015
Language eng
Abstract In the face of diminishing therapeutic options for the treatment of infections caused by multidrug-resistant, Gram-negative bacteria, clinicians are increasingly using colistin and polymyxin B. These antibiotics became available clinically in the 1950s, when understanding of antimicrobial pharmacology and regulatory requirements for approval of drugs was substantially less than today. At the 1st International Conference on Polymyxins in Prato, Italy, 2013, participants discussed a set of key objectives that were developed to explore the factors affecting the safe and effective use of polymyxins, identify the gaps in knowledge, and set priorities for future research. Participants identified several factors that affect the optimum use of polymyxins, including: confusion caused by several different conventions used to describe doses of colistin; an absence of appropriate pharmacopoeial standards for polymyxins; outdated and diverse product information; and uncertainties about susceptibility testing and breakpoints. High-priority areas for research included: better definition of the effectiveness of polymyxin-based combination therapy compared with monotherapy via well designed, randomised controlled trials; examination of the relative merits of colistin versus polymyxin B for various types of infection; investigation of pharmacokinetics in special patient populations; and definition of the role of nebulised polymyxins alone or in combination with intravenous polymyxins for the treatment of pneumonia. The key areas identified provide a roadmap for action regarding the continued use of polymyxins, and are intended to help with the effective and safe use of these important, last-line antibiotics.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Published online ahead of print 21 Oct 2014

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: UQ Centre for Clinical Research Publications
Official 2015 Collection
 
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