Medical News Stories
What is the Efficacy and Safety of Colistin for the Treatment of Ventilator-Associated Pneumonia? A Systemic Review and Meta-Regression
Study Question: What is the safety and efficacy of intravenous and aerosolized colistin for the treatment of ventilator-associated pneumonia (VAP)?
Study Description: This article was a quantitative amalgamation of studies that reported safety and efficacy of IV and/or aerosolized colistin for treatment of VAP.
Results: Six two-arm (colistin vs. control therapy) and 13 single-arm were included in the meta-regression, although the two types of studies were analyzed separately. No difference was found in the 2-arm studies with respect to clinical outcome, microbiologic outcome, mortality, length of stay, or safety (e.g., rates of nephrotoxicity). The results from the single-arm studies mirrored that of the 2-arm studies.
Conclusion(s): Colistin may be as safe and as efficacious as standard antibiotics for the treatment of VAP.
Perspective: A power analysis found that the meta-regression was underpowered to detect a difference in clinical outcome. Moreover, a third of the studies in the 2-arm group used inhaled formulations of colistin, which has a safety profile different from that of intravenous colistin; lumping the studies together makes it difficult to draw conclusions about each formulation’s safety profiles and may or may not have been appropriate with respect to efficacy. While this analysis provides an excellent aggregation of the sparse data on the use of inhaled colistin in VAP, the critical care community is still left with too few data to draw practice-changing conclusions with regard to safety and efficacy at this time.