Colistin use in the Neonatal Intensive Care Unit of Algala Maternity Hospital

Colistin, a polymyxin antibiotic, is commercially available in two forms: colistin sulphate (oral or topical powder) and colistimethate sodium (CMS) (parenteral formulation) 1. When used for neonatal multidrug resistance-gram-negative infections (e.g., carbapenem-resistant Acinetobacter, Klebsiella, and Pseudomonas), i.v. colistin is frequently effective (clinical response rate is 70.0%-90.0%) and is considered a last-resort option 2, 3. However, pharmacokinetics in neonates differ from those in older children/adults. A number of pharmacokinetic studies suggest standard low doses may produce subtherapeutic plasma colistin concentrations. Some guidance recommends a loading dose strategy in neonates/infants 4-6. The case studied is a 3.7 kg male post-emergency section term 38 weeks plus two days, 2025. An echo done and revealed a ventricular septal defect and a small left kidney medication start with ampicillin and cefotaxime as first-line prophylactic treatment in the Neonatal Intensive Care Unit (NICU), Algala Maternity Hospital, Tripoli, Libya. The subsequent medicines are described: Phenobarbitone for convulsion, and meropenem, amikacin as second line after C-reactive protein (CRP) was raised calcium gluconate 10.0% for hypocalcemia, furosemide and spironolactone for cardiac problem. Colistin was used in this stage because CRP raised again and there was no response to the third line of antibiotics 3, 7. In the present case, the Clinical Pharmacists have the following issues regarding colistin use.