TABLE 6.

Studies that primarily assessed the efficacy and/or toxicity of inhaled polymyxins with or without intravenous polymyxinsa

ReferenceStudy designInfection type (%)No. of patients treated with colistin (delivery)Comparator groupOutcomeRespiratory adverse eventsNephrotoxicity or neurotoxicity
Michalopoulos et al. (367)Retrospective cohort studyPneumonia (100)8 (supplemental nebulized colistin in conjunction with i.v. antibiotics) (seven infected with A. baumannii and one infected with P. aeruginosa)45 patients receiving i.v. colistinClinical cure (88% in nebulized + i.v. group vs 67% in i.v.-only group) (P = 0.67), mortality (13% vs 24%, respectively) (P = 0.41)NilNil
Kwa et al. (305)Retrospective case seriesPneumonia (100)21 (nebulized colistin) (17 infected with A. baumannii and 4 infected with P. aeruginosa)NAFavorable response (86%), microbiological eradication (86% [documented for 52% of cases]), mortality (all causes, 46.7%; related to pneumonia, 14.3%)One (5%) patient developed bronchospasmNil
Berlana et al. (30)Retrospective case seriesRespiratory (89), urinary (9), blood (2.5), or CNS (2.5)80 (68 received nebulized colistin only, 3 received nebulized and parenteral colistin, 2 received parenteral and intrathecal colistin, and 7 received parenteral colistin only) (69 infected with A. baumannii and 11 infected with P. aeruginosaNAMortality (18%), microbiological clearance (92%)NilNA
  • a NA, not assessed.