Pharmacokinetic Characteristics of Nebulized Colistimethate Sodium Using Two Different Types of Nebulizers in Critically Ill Patients with Ventilator-Associated Respiratory Infections
<i>Background:</i> Rising antimicrobial resistance has led to a revived interest in inhaled colistin treatment in the critically ill patient with ventilator-associated respiratory infection (VARI). Nebulization via vibrating mesh nebulizers (VMNs) is considered the current standard-of-ca...
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| Format: | Article |
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MDPI AG
2022-11-01
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| Series: | Antibiotics |
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| Online Access: | https://www.mdpi.com/2079-6382/11/11/1528 |
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| author | Anna Kyriakoudi Konstantinos Pontikis Georgia Valsami Stavrina Avgeropoulou Efthymios Neroutsos Eirini Christodoulou Eleni Moraitou Sophia L. Markantonis Aristides Dokoumetzidis Jordi Rello Antonia Koutsoukou |
| author_facet | Anna Kyriakoudi Konstantinos Pontikis Georgia Valsami Stavrina Avgeropoulou Efthymios Neroutsos Eirini Christodoulou Eleni Moraitou Sophia L. Markantonis Aristides Dokoumetzidis Jordi Rello Antonia Koutsoukou |
| author_sort | Anna Kyriakoudi |
| collection | DOAJ |
| description | <i>Background:</i> Rising antimicrobial resistance has led to a revived interest in inhaled colistin treatment in the critically ill patient with ventilator-associated respiratory infection (VARI). Nebulization via vibrating mesh nebulizers (VMNs) is considered the current standard-of-care, yet the use of generic jet nebulizers (JNs) is more widespread. Few data exist on the intrapulmonary pharmacokinetics of colistin when administered through VMNs, while there is a complete paucity regarding the use of JNs. <i>Methods:</i> In this study, 18 VARI patients who received 2 million international units of inhaled colistimethate sodium (CMS) through a VMN were pharmacokinetically compared with six VARI patients who received the same drug dose through a JN, in the absence of systemic CMS administration. <i>Results:</i> Surprisingly, VMN and JN led to comparable formed colistin exposures in the epithelial lining fluid (ELF) (median (IQR) AUC<sub>0–24</sub>: 86.2 (46.0–185.9) mg/L∙h with VMN and 91.5 (78.1–110.3) mg/L∙h with JN). The maximum ELF concentration was 10.4 (4.7–22.6) mg/L and 7.4 (6.2–10.3) mg/L, respectively. <i>Conclusions:</i> Based on our results, JN might be considered a viable alternative to the theoretically superior VMN. Therapeutic drug monitoring in the ELF can be advised due to the observed low exposure, high variability, and appreciable systemic absorption. |
| first_indexed | 2024-03-09T19:20:24Z |
| format | Article |
| id | doaj.art-c157c2ee17a44b0b8b7cae363dffc116 |
| institution | Directory Open Access Journal |
| issn | 2079-6382 |
| language | English |
| last_indexed | 2024-03-09T19:20:24Z |
| publishDate | 2022-11-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antibiotics |
| spelling | doaj.art-c157c2ee17a44b0b8b7cae363dffc1162023-11-24T03:27:53ZengMDPI AGAntibiotics2079-63822022-11-011111152810.3390/antibiotics11111528Pharmacokinetic Characteristics of Nebulized Colistimethate Sodium Using Two Different Types of Nebulizers in Critically Ill Patients with Ventilator-Associated Respiratory InfectionsAnna Kyriakoudi0Konstantinos Pontikis1Georgia Valsami2Stavrina Avgeropoulou3Efthymios Neroutsos4Eirini Christodoulou5Eleni Moraitou6Sophia L. Markantonis7Aristides Dokoumetzidis8Jordi Rello9Antonia Koutsoukou10Intensive Care Unit, 1st Department of Pulmonology, Medical School, National & Kapodistrian University of Athens, General Hospital for the Diseases of the Chest “I Sotiria”, 11527 Athens, GreeceIntensive Care Unit, 1st Department of Pulmonology, Medical School, National & Kapodistrian University of Athens, General Hospital for the Diseases of the Chest “I Sotiria”, 11527 Athens, GreeceDepartment of Pharmacy, School of Health Sciences, National & Kapodistrian University of Athens, 15784 Athens, GreeceIntensive Care Unit, 1st Department of Pulmonology, Medical School, National & Kapodistrian University of Athens, General Hospital for the Diseases of the Chest “I Sotiria”, 11527 Athens, GreeceDepartment of Pharmacy, School of Health Sciences, National & Kapodistrian University of Athens, 15784 Athens, GreeceDepartment of Pharmacy, School of Health Sciences, National & Kapodistrian University of Athens, 15784 Athens, GreeceMicrobiology Department, General Hospital for the Diseases of the Chest “I Sotiria”, 11527 Athens, GreeceDepartment of Pharmacy, School of Health Sciences, National & Kapodistrian University of Athens, 15784 Athens, GreeceDepartment of Pharmacy, School of Health Sciences, National & Kapodistrian University of Athens, 15784 Athens, GreeceClinical Research in Pneumonia (CRIPS), Vall d’Hebron Institute of Research, 08035 Barcelona, SpainIntensive Care Unit, 1st Department of Pulmonology, Medical School, National & Kapodistrian University of Athens, General Hospital for the Diseases of the Chest “I Sotiria”, 11527 Athens, Greece<i>Background:</i> Rising antimicrobial resistance has led to a revived interest in inhaled colistin treatment in the critically ill patient with ventilator-associated respiratory infection (VARI). Nebulization via vibrating mesh nebulizers (VMNs) is considered the current standard-of-care, yet the use of generic jet nebulizers (JNs) is more widespread. Few data exist on the intrapulmonary pharmacokinetics of colistin when administered through VMNs, while there is a complete paucity regarding the use of JNs. <i>Methods:</i> In this study, 18 VARI patients who received 2 million international units of inhaled colistimethate sodium (CMS) through a VMN were pharmacokinetically compared with six VARI patients who received the same drug dose through a JN, in the absence of systemic CMS administration. <i>Results:</i> Surprisingly, VMN and JN led to comparable formed colistin exposures in the epithelial lining fluid (ELF) (median (IQR) AUC<sub>0–24</sub>: 86.2 (46.0–185.9) mg/L∙h with VMN and 91.5 (78.1–110.3) mg/L∙h with JN). The maximum ELF concentration was 10.4 (4.7–22.6) mg/L and 7.4 (6.2–10.3) mg/L, respectively. <i>Conclusions:</i> Based on our results, JN might be considered a viable alternative to the theoretically superior VMN. Therapeutic drug monitoring in the ELF can be advised due to the observed low exposure, high variability, and appreciable systemic absorption.https://www.mdpi.com/2079-6382/11/11/1528inhaled colistincolistin pharmacokineticsELF colistin concentrationvibrating mesh nebulizerjet nebulizercritically ill |
| spellingShingle | Anna Kyriakoudi Konstantinos Pontikis Georgia Valsami Stavrina Avgeropoulou Efthymios Neroutsos Eirini Christodoulou Eleni Moraitou Sophia L. Markantonis Aristides Dokoumetzidis Jordi Rello Antonia Koutsoukou Pharmacokinetic Characteristics of Nebulized Colistimethate Sodium Using Two Different Types of Nebulizers in Critically Ill Patients with Ventilator-Associated Respiratory Infections Antibiotics inhaled colistin colistin pharmacokinetics ELF colistin concentration vibrating mesh nebulizer jet nebulizer critically ill |
| title | Pharmacokinetic Characteristics of Nebulized Colistimethate Sodium Using Two Different Types of Nebulizers in Critically Ill Patients with Ventilator-Associated Respiratory Infections |
| title_full | Pharmacokinetic Characteristics of Nebulized Colistimethate Sodium Using Two Different Types of Nebulizers in Critically Ill Patients with Ventilator-Associated Respiratory Infections |
| title_fullStr | Pharmacokinetic Characteristics of Nebulized Colistimethate Sodium Using Two Different Types of Nebulizers in Critically Ill Patients with Ventilator-Associated Respiratory Infections |
| title_full_unstemmed | Pharmacokinetic Characteristics of Nebulized Colistimethate Sodium Using Two Different Types of Nebulizers in Critically Ill Patients with Ventilator-Associated Respiratory Infections |
| title_short | Pharmacokinetic Characteristics of Nebulized Colistimethate Sodium Using Two Different Types of Nebulizers in Critically Ill Patients with Ventilator-Associated Respiratory Infections |
| title_sort | pharmacokinetic characteristics of nebulized colistimethate sodium using two different types of nebulizers in critically ill patients with ventilator associated respiratory infections |
| topic | inhaled colistin colistin pharmacokinetics ELF colistin concentration vibrating mesh nebulizer jet nebulizer critically ill |
| url | https://www.mdpi.com/2079-6382/11/11/1528 |
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