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Colistin

Ein altes Antibiotikum in neuem Glanz?

Colistin

Renaissance of an old antibiotic?

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Zusammenfassung

Aufgrund seiner Wirksamkeit gegen multiresistente gramnegative Bakterien erlebt Colistin – wie andere ältere Antibiotika – eine überraschende Renaissance. Die optimierte Dosierung und die pharmakodynamischen Eigenschaften der Substanz waren bisher kaum systematisch untersucht worden. Neuere Daten ermöglichen nun erstmals eine individualisierte Dosierung, die auf optimale Verhältnisse zwischen der Fläche unter der Konzentrations-Zeit-Kurve (AUC) von Colistin und der Erregerempfindlichkeit (minimale Hemmkonzentration) abzielt. Heute ist klar, dass die Dosisempfehlungen der Hersteller zum Erreichen der angestrebten Colistinexposition meist deutlich überschritten werden müssen. Klar ist auch, dass selbst bei Einsatz der höchsten bisher untersuchten Dosen eine Monotherapie mit Colistin in bestimmten klinischen Situationen nicht hocheffektiv ist. Colistin sollte daher nur bei fehlenden alternativen Therapieoptionen und möglichst in Kombination mit anderen Antibiotika eingesetzt werden. Unabhängig von den Ergebnissen der Empfindlichkeitsprüfung sind Carbapeneme die vielversprechendsten Kombinationspartner.

Abstract

Owing to its activity against multidrug-resistant gram-negative bacteria, colistin (like other older antibiotics) is experiencing a surprising resurgence. In the 50 years following its discovery, little effort was put into studying its dosing and pharmacodynamic properties. Recent data have been filling the gaps, and individualized dosing recommendations targeting an optimal AUC/MIC ratio have been published. According to these data, pharmacokinetic targets will clearly be missed without exceeding the currently recommended dosages. Even the highest doses studied so far do not universally result in sufficient drug levels. Therefore, colistin remains a last-resort drug which should be used in combination with other antibiotics only. Regardless of the presence of resistance, carbapenems seem to be the most promising combination partners.

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Interessenkonflikt

Der korrespondierende Autor gibt für sich und seinen Koautor an, dass kein Interessenkonflikt besteht. H. Stocker hat Forschungsförderung, Reisebeihilfen oder Honorare für Vorträge oder Beratertätigkeiten von Abbott, Astellas Pharma GmbH, Bristol-Myers Squibb, Boehringer Ingelheim, MSD, Pfizer und ViiV Healthcare erhalten. W.V. Kern hat Forschungsförderung, Reisebeihilfen oder Honorare für Vorträge oder Beratertätigkeiten von Astellas, AstraZeneca, Bayer, BMG, BMBF, Boehringer, Bundesärztekammer, DFG, DGI, ESCMID, EU, Gilead, GSK, Janssen, Kassenärztliche Bundesvereinigung, Landesgesundheitsamt Stuttgart, MSD, Pfizer, Siemens, Universität Bremen/Bertelsmann, RKI und Stiftung Warentest erhalten.

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Authors and Affiliations

  1. Abteilung für Gastroenterologie und Infektiologie, Vivantes Auguste-Viktoria-Klinikum, Rubensstr. 125, 12157, Berlin, Deutschland

    H. Stocker

  2. Zentrum Infektiologie und Reisemedizin, Medizinische Klinik, Universitätsklinikum Freiburg, Freiburg, Deutschland

    W.V. Kern

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Correspondence to H. Stocker.

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Stocker, H., Kern, W. Colistin. Internist 54, 936–944 (2013). https://doi.org/10.1007/s00108-012-3141-3

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