Veterinarska stanica, Vol. 49 No. 4, 2018.
Pregledni rad
Colistin, a last defence polypeptide antibiotic against invasive gram-negative bacteria
Nina Bilandžić
Ivana Varenina
Božica Solomun Kolanović
Đurđica Božić Luburić
Ines Varga
Svjetlana Terzić
Sažetak
Colistin is a polymyxin, a bactericidal antibiotic polypeptide with wide spectrum action against Gram-negative bacteria including Acinetobacter spp., Pseudomonas aeruginosa, Klebsiella spp. and Enterobacter spp. Its antibacterial activity was already recognized in the 1940s. However, due to significant side effects such as nephrotoxicity and neurotoxicity, polymyxins have seldom been used since the 1970s, when less toxic aminoglycosides and other antibiotics were made available on the market. Colistin was only used intravenously in the treatment of patients with lung infections with Gram- negative bacteria or cystic fibrosis. The mechanism of antimicrobial activity of colistin is that it binds to the lipopolysaccharides and phospholipids in the outer cell membrane of Gram-negative bacteria. They competitively expel bivalent cations from the phosphate groups of membrane lipids, leading to external cell membrane disorders, leakage of intracellular content, and bacterial death. Two forms of colistin, colistin sulphate and colistimethate sodium are commercially available. With regard to colistin dosage, dosing and efficacy dosing optimization studies are still required The occurrence of severe infections with Gram-negative bacteria, such as Pseudomonas aeruginosa and Acinetobacter baumannii, is a major problem worldwide, as they are resistant to most classes of commercially available antibiotics, and new antibiotics with antibacterial activity against these bacteria are lacking. Therefore, the therapeutic possibilities of polymyxins were re-examined and the reuse of these polypeptide antibiotics, i.e. polymyxin B and colistin, considered. In veterinary medicine, colistin has been used for the treatment of infections caused by Enterobacteriaceae in farm animals. Today, it is one of the five most commonly used antibiotics in food-producing animals within the EU. Consumption of colistin in animals is far greater than in humans. Its use has increased in recent years partly due to the development of resistance to other classes of antibiotics. The European Medicines Agency (EMA) presented a report on the sale of antimicrobial veterinary drugs using data from 30 EU countries for the period 2010–2015. In Croatia, colistin is used in the form of colistin sulphate in the treatment of intestinal infections caused by non-invasive, colistin-sensitive E. coli in cattle, pigs, hens and sheep. In 2015, sales of polymyxins accounted for 2.5% of the total sales of veterinary drugs in Croatia, while in Spain, sales accounted for 8.7% of the total sales. The EMA has recommended that colistin-containing medicines should only be used for second-line treatment in animals and that their sales should be minimized in all EU Member States in order to reduce the risk of antimicrobial resistance. Given the existing data, it is believed that colistin is a “last defence” antibacterial therapeutic against Gram-negative pathogens resistant to multiple drugs in the 21st century.
Ključne riječi
colistin; polymyxins; Gram-negative bacteria; multidrug-resistance; veterinary drug
Hrčak ID:
223136
URI
Datum izdavanja:
22.7.2018.
Posjeta: 6.211 *