The role of the clinical pharmacist in the evaluation of appropriate use of colistin in the intensive care unit

Colistin has an important role in the treatment of multi-drug resistant (MDR) Gram-negative infections and in the presence of resistance to other antibiotics. Proper preparation of colistin, use of appropriate dose, adjustment of renal dose, use with nephrotoxic agents are important for the effectiveness and safety of treatment. In the first 4 months of this prospective thesis study, the suitability of the use of colistin alone was evaluated by the clinical pharmacist and no suggestions were made (observation group), and in the next 4 months, recommendations were made by the clinical pharmacist (intervention group). The impact of clinical pharmacist on treatment compliance and clinical results was investigated by comparing the percentage of compliance between the observation group and the intervention group. ''International Consensus Guidelines for the Optimal Use of the Polymyxins'' were used to evaluate the suitability of colistin use. Since the study was conducted in a single intensive care unit, the patient population frequency was low, and the study had a specific duration, the sample size was limited. 51 people were included in the observation group and 40 people in the intervention group. While the total appropriate use of colistin was 21,6% in the observation group, it increased to 97,5% in the intervention group, and the clinical pharmacist intervention was found to be statistically significant (p<0,05). In addition, the incidence of nephrotoxicity decreased from 72,7% in the observation group to 35% in the intervention group and was found to be statistically significant (p<0,05). In this thesis study, it was shown that clinical pharmacists working in cooperation with physicians increased the appropriate use of colistin and reduced the development of nephrotoxicity, which is the most important side effect of colistin.