Begin main content

Colistin for Prophylactic Use in Non-Cystic Fibrosis Bronchiectasis or COPD with Exacerbations: A Review of Clinical and Cost-Effectiveness and Guidelines

Last updated: June 27, 2017
Project Number: RC0896-000
Product Line: Rapid Response
Research Type: Drug
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the clinical effectiveness of colistin for the prophylactic treatment of adults with either non-cystic fibrosis bronchiectasis or patients with chronic obstructive pulmonary disease experiencing exacerbations?
  2. What is the cost-effectiveness of colistin for the prophylactic treatment of adults with either non-cystic fibrosis bronchiectasis or patients with chronic obstructive pulmonary disease experiencing exacerbations?
  3. What are the evidence-based guidelines associated with the use of colistin for the prophylactic treatment of adults with either non-cystic fibrosis bronchiectasis or patients with chronic obstructive pulmonary disease experiencing exacerbations?

Key Message

Indirect comparisons from a systematic review between inhaled antibiotics colistin, ciprofloxacin, and the aminoglycosides tobramycin and amikacin showed that ciprofloxacin is more efficient than colistin and aminoglycosides in reducing sputum bacterial load in patients with stable non-cystic fibrosis bronchiectasis. Inhaled aminoglycosides tobramycin, amikacin and gentamicin significantly increased the risk of bronchospasm while inhaled ciprofloxacin and colistin were not significantly associated with the occurrence of this adverse event. A head-to-head comparison between inhaled colistin and tobramycin showed similar results in the number of hospital admissions due to exacerbations, duration of hospitalizations, and adverse events. Emergence of resistance to colistin was lower than resistance to tobramycin. There was no evidence found on patients with COPD experiencing exacerbations. There was no evidence found on cost-effectivenessor evidence-based guidelines regarding the use of colistin for the prophylactic treatment of adults with either non-CF bronchiectasis or patients with COPD experiencing exacerbations.