Abstract
Colistin has been extensively used since the middle of the last century in animals, particularly in swine, for the control of enteric infections. Colistin is presently considered the last line of defense against human infections caused by multidrug-resistant Gram-negative organisms such as carbapenemase-producer Enterobacterales, Acinetobacter baumanni, and Pseudomonas aeruginosa. Transferable bacterial resistance like mcr-genes was reported in isolates from both humans and animals. Researchers actively seek strategies to reduce colistin resistance. The definition of guidelines for colistin therapy in veterinary and human medicine is thus crucial. The ban of colistin use in swine as a growth promoter and for prophylactic purposes, and the implementation of sustainable measures in farm animals for the prevention of infections, would help to avoid resistance and should be encouraged. Colistin resistance in the human–animal–environment interface stresses the relevance of the One Health approach to achieve its effective control. Such measures should be addressed in a cooperative way, with efforts from multiple disciplines and with consensus among doctors, veterinary surgeons, and environment professionals. A revision of the mechanism of colistin action, resistance, animal and human use, as well as colistin susceptibility evaluation is debated here.
Highlights
Colistin (Polymyxin E) is a polycationic peptide antimicrobial, discovered in 1949 in Japan, produced by Bacillus polymyxa
It should be remembered that administered antibiotics are not 100% metabolized by animals or humans; many are excreted in an active form via the feces or urine
An interdisciplinary collaboration and communication between all the specialists involved is necessary to develop a universal strategy that fosters the reduction of the emergence of resistance to colistin in human, veterinary medicine, and the environment
Summary
Colistin (Polymyxin E) is a polycationic peptide antimicrobial, discovered in 1949 in Japan, produced by Bacillus polymyxa. It belongs to the polymyxin class of antibiotics, with hydrophilic and lipophilic properties. Two forms of colistin are available: a prodrug, colistin methanesulfonate sodium (CMS), for parenteral use, and colistin sulfate (CS) for oral, inhalator, or topical use [4] It was first used in human and veterinary medicine in 1952, but between the 1970s and 1980s, its medical use was almost abolished, thereby persisting the veterinary use. Colistin is considered by the European Medicines Agency (EMA) as antibiotics critically important in human medicine—Category B—“Restrict”. Antibiotic utilization should rely upon the performance of an antimicrobial susceptibility test (AST), those included in Category B [11]
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