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Original Research
Paediatric colistin prescribing practices in South Africa: A clinician survey
Submitted: 24 February 2025 | Published: 05 August 2025
About the author(s)
Veshni Pillay-Fuentes Lorente, Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South AfricaTrusha Nana, Division of Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and National Health Laboratory Service, Johannesburg, South Africa
Marianne Black, Division of Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and Lancet Laboratories, Johannesburg, South Africa
Gary Reubenson, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Reenu Thomas, Division of Neonatology, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Angela Dramowski, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
Adrie Bekker, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
Nicolette du Plessis, Division of Paediatric Infectious Diseases, Department of Paediatrics, University of Pretoria, Tshwane, South Africa
Despina Demopoulos, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Vindana Chibabhai, Division of Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and Centre for Healthcare Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
Abstract
Background: Increasing multidrug-resistant bacterial infections are a global health challenge. Colistin, a polymyxin antimicrobial, has activity against some resistant strains, and despite its adverse effects, it presents a last-line option to treat resistant Gram-negative pathogens. However, paediatric colistin prescribing guidelines are lacking.
Objectives: To determine paediatric colistin prescribing practices and challenges in South Africa (SA) to aid the development of a paediatric colistin guideline.
Method: We conducted an anonymous online survey of registered medical practitioners in SA who prescribed colistin to patients aged ≤ 14 years in the past 12 months.
Results: Of 196 participants, 71.9% (n = 141/196) completed the survey. Eighty-six respondents (n = 86/146; 58.9%) reported prescribing loading doses (LD), with the median LD and maintenance doses of 150 000 IU/kg/dose (interquartile range (IQR), 75 000–150 000) and 50 000 IU/kg/dose (IQR, 40 000–50 000), respectively. Empiric colistin use was reported by 47.2% (n = 69/146), of whom 46.3% (n = 32/69) continued empiric colistin for ≥ 72 h. Using the Likert scale, respondents highly perceived that therapeutic drug monitoring should be readily available (mean = 3.97). The perception that prescribing colistin should be advised by a microbiologist or infectious disease specialist had a mean score of 2.97, indicating moderate agreement.
Conclusion: This survey demonstrated varied paediatric colistin prescribing practices. Recently, a new evidence-based paediatric guideline for colistin use in SA has been published. A follow-up survey will be conducted to assess the impact of the guideline on paediatric colistin prescribing practices in SA.
Contribution: This study highlighted paediatric colistin dosing practices in the absence of a paediatric colistin guideline in South Africa.
Keywords
Sustainable Development Goal
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