colistin sulfate + neomycin sulfate

This decolonization regimen was developed and evaluated by the University Hospital, Geneva, to target intestinal and urinary colonization of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) in hospitalized patients. The core therapeutic approach utilizes a combination of oral, non-absorbable antibiotics—colistin sulfate and neomycin sulfate—to achieve selective digestive decontamination. Colistin acts by disrupting the bacterial outer membrane through binding with lipopolysaccharides, while neomycin inhibits protein synthesis by targeting the 30S ribosomal subunit. For patients with ESBL-E bacteriuria, the regimen is supplemented with either nitrofurantoin or norfloxacin. A randomized, double-blind, placebo-controlled Phase 4 trial (NCT00826670) demonstrated that while the regimen could temporarily suppress ESBL-E carriage, it did not result in significant long-term decolonization, with success rates at four weeks post-treatment not significantly differing from placebo.

Other names

Decolonization-University Hospital, Geneva-colonization with ESBL-producing EnterobacteriaceaeSelective digestive decontamination for ESBL-EColistin + Neomycin decolonization regimen