Vol.70 No.1 January 2022
A case of apnea after administration of colistin that disappeared by prolonging the administration interval
1)Department of Pharmacy, Tokyo Women's Medical University Hospital, 8-1 Kawada, Shinjuku-ku, Tokyo, Japan
2)Department of Infectious Diseases, Tokyo Women's Medical University Hospital
Abstract
The patient was an 86-year-old woman who was receiving colistin (CL) 66 mg (1.5 mg/kg) every 36 hours and aztreonam 2 g every 12 hours for complicated pyelonephritis caused by multidrug-resistant Pseudomonas aeruginosa. The patient began to exhibit multiple apnea episodes 3 days after the start of CL administration. Even though the apnea episodes were suspected as a manifestation of CL neurotoxicity the CL administration was continued, as there was no other therapeutic option, with extension of the dosing interval to 48 hours from 36 hours. Five days after this change in the dosing schedule, the apnea episodes disappeared. As urine cultures on days 4, 6 and 11 of treatment were negative, the CL administration was discontinued on day 13.
CL neurotoxicity is considered as being dose-dependent. Few reports of CL neurotoxicity have been published in recent years, because currently approved doses are lower than those used previously and have to be adjusted for renal function impairment. In our patient reported here, the dosage was reduced based on the instructions in the package insert for the drug in Japan. The patient manifested apnea despite showing no evidence of acute kidney injury prior to the start of CL administration. Extension of the CL dosing interval improved the apnea in our case, without compromising the clinical and bacteriological effects of the drug.
Key word
colistin, multidrug-resistant Pseudomonas aeruginosa, apnea
Received
August 4, 2021
Accepted
October 15, 2021
Jpn. J. Chemother. 70 (1): 88-93, 2022
