TABLE 6.

Studies that primarily assessed the efficacy and/or toxicity of inhaled polymyxins with or without intravenous polymyxins^a

Reference	Study design	Infection type (%)	No. of patients treated with colistin (delivery)	Comparator group	Outcome	Respiratory adverse events	Nephrotoxicity or neurotoxicity
Michalopoulos et al. (367)	Retrospective cohort study	Pneumonia (100)	8 (supplemental nebulized colistin in conjunction with i.v. antibiotics) (seven infected with A. baumannii and one infected with P. aeruginosa)	45 patients receiving i.v. colistin	Clinical cure (88% in nebulized + i.v. group vs 67% in i.v.-only group) (P = 0.67), mortality (13% vs 24%, respectively) (P = 0.41)	Nil	Nil
Kwa et al. (305)	Retrospective case series	Pneumonia (100)	21 (nebulized colistin) (17 infected with A. baumannii and 4 infected with P. aeruginosa)	NA	Favorable response (86%), microbiological eradication (86% [documented for 52% of cases]), mortality (all causes, 46.7%; related to pneumonia, 14.3%)	One (5%) patient developed bronchospasm	Nil
Berlana et al. (30)	Retrospective case series	Respiratory (89), urinary (9), blood (2.5), or CNS (2.5)	80 (68 received nebulized colistin only, 3 received nebulized and parenteral colistin, 2 received parenteral and intrathecal colistin, and 7 received parenteral colistin only) (69 infected with A. baumannii and 11 infected with P. aeruginosa	NA	Mortality (18%), microbiological clearance (92%)	Nil	NA

^aNA, not assessed.