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Hypotension Following Treatment with Aerosolized Colistin in a Patient with Multidrug-Resistant Pseudomonas aeruginosa

Scholarship Recipient, Pharmacy Services Department, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia

Abdullah M Almohaizeie, PharmD

Senior Clinical Pharmacist in Infectious Disease Pharmacotherapy, Pharmacy Services Department, King Faisal Specialist Hospital & Research Centre

Reprints: Mr. Hakeam, King Faisal Specialist Hospital & Research Centre, PO Box 3354 Riyadh 11211 MBC# 11, Saudi Arabia, fax 96614427608, hakeam{at}kfshrc.edu.sa

OBJECTIVE: To report a case of a man who developed temporary hypotension after aerosolized colistin administration.

CASE SUMMARY: A 62-year-old Arab male was admitted to the intensive care unit for respiratory failure and septic shock. Simultaneous therapy using intravenous and aerosolized colistin was initiated for the management of multidrug-resistant Pseudomonas aeruginosa. A significant but transient drop in blood pressure occurred when aerosolized colistin was introduced. However, when it was stopped, but intravenous administration was continued, no hypotension was observed. Moreover, the combined use of aerosolized amikacin with intravenous colistin did not significantly affect blood pressure.

DISCUSSION: It is widely accepted that aerosolization allows safe administration of colistin in the absence of significant systemic adverse effects. However, in our patient, hypotension was observed with aerosolized colistin, but not with the systemic formulation. The lack of adverse effects with administration of aerosolized amikacin in this patient demonstrates the safety of the aerosolization technique. Use of the Naranjo scale indicated a probable relationship between hypotension and aerosolized colistin administration.

CONCLUSIONS: This case suggests that hypotension may be induced with administration of aerosolized colistin. Although this effect is rare, clinicians should be aware that hypotension may develop in critically ill patients following aerosolized colistin treatment.

Key Words: aerosolized, amikacin, colistin, hypotension, polymyxin

Published Online, August 8, 2006. www.theannals.com, DOI 10.1345/aph.1H019