The old antibiotic colistin: an update on its use in children

Colistin is an old antibiotic which has rekindled the interest of infectious doctors worldwide. It is a polypeptide antibiotic belonging to the polymyxin class of antibiotics. It was discovered in 1947 and clinicians started using it for gram-negative infections. But its main drawback of nephrotoxicity and availability of better and safe antibiotics led to its use getting obsolete. But when the bacteria showed alarming resistance to the higher antibiotics, colistin was revisited for such antimicrobial resistant strains of bacteria. Efficacy of colistin against multi-drug resistant bacteria makes it an antibiotic of choice in intensive care setups. It is used as a last-line in these severe life-threatening infections in adults and children. Despite having been known for over seventy years now, there are significant lacunae in knowledge on its pharmacokinetics, pharmacodynamics, and correct dosing. It also has the problem of variable labelling by manufacturers and resistance is also rising steadily to this antibiotic. Research is ongoing to collect more scientific data on its mechanism of action and pharmacokinetics but more studies are needed especially in children to be able to extend its use in them. Colistin does hold promise in the world of infections to tackle resistant nosocomial infections and prevent emergence of superbugs.