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Case Report |
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Induced Tolerance to Nebulized
Colistin After Severe Reaction to the Drug |
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J Domínguez-Ortega, 1 E
Manteiga, 2 C Abad-Schilling, 1 MA
Juretzcke, 3 J Sánchez-Rubio, 4 C
Kindelan 1 |
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1 Unit of Allergology, Hospital
Universitario de Getafe, Madrid, Spain
2 Critical Care Service, Hospital Universitario de
Getafe, Madrid, Spain
3 Pneumology Section, Hospital Universitario de Getafe,
Madrid, Spain
4 Pharmacy Service, Hospital Universitario de Getafe,
Madrid, Spain |
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J Investig Allergol Clin Immunol
2007; Vol. 17(1): 59-61 |
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Abstract |
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Daily nebulized
colistin therapy has
been used as
maintenance therapy
for patients with
chronic Pseudomonas
aeruginosa infection
and in treatment
protocols aimed at
eradicating early P
aeruginosa
infection. Colistin-induced
nephrotoxicity and
mild neurotoxic
effects have been
described but
hypersensitivity
reactions are rare.
However, bronchial
constriction has
been reported
associated with the
inhalation of the
antibiotic. We
report the case of a
63-year-old man who
had been diagnosed
with bronchiectasis
and bronchopleural
fistula and who
developed severe
bronchospasm when
using nebulized
colistin. A skin
prick test (80 mg/mL)
with colistin was
performed and was
negative. An
intradermal test was
not performed due to
its possible
irritant effect. As
our patient suffered
from a tobramycin-resistant
P aeruginosa
infection, we
started a procedure
to induce tolerance
to 80 mg colistin (8
mg, 16 mg, 24 mg, 32
mg, 40 mg, 80 mg)
nebulized in
30-minutes-intervals.
No changes in forced
expiratory volume in
1 second values were
observed and the
patient continues on
treatment twice
daily after the
tolerance induction
with no new episodes
of bronchospasm. We
report the fi rst
successful procedure
to induce tolerance
to colistin after
escalating doses of
inhaled colistin.
Key words:
Colistin.
Bronchospasm.
Desensitization
procedure. Tolerance
induction |
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