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Colistin

    Brands

    DEA Class; Rx

    Common Brand Names; colistimethate sodium, Coly Mycin M

    • Antibiotics, Other

    Structurally similar to polymyxin B; colistimethate hydrolyzed to colistin in vitro or in vivo

    Cationic detergent that damages bacterial cytoplasmic membrane, causing cell death

    Indicated for treatment of Susceptible Infections

    Gram-neg. infection (e.g., Enterobacter aerogenes, E. coli, Klebsiella, Pseudomonas) unresponsive to other antibiotics

    Multi-drug resistant gram-neg. infection

    Hypersensitivity

    • Dizziness
    • Paresthesia
    • Tingling of extremities and tongue
    • Neurotoxicity
    • Nephrotoxicity
    • Acute respiratory failure (inhalation route)
    • Respiratory tract paralysis
    • Slurred speech
    • Vertigo
    • Seizures
    • Anaphylaxis

    Do not exceed 5 mg/kg/day (as colistin base) with normal renal function (see Dosing for renal impairment)

    Not indicated for infections by Proteus or Neisseria (most strains are resistant)

    Risk of nephrotoxicity, neurotoxicity; discontinue if elevated BUN/creatinine

    Risk of respiratory arrest in myasthenia gravis or concomitant anesthetics or neuromuscular blocking drugs

    Risk of C. difficile-associated pseudomembranous colitis

    Sedative effects may impair driving, operating machinery

    Colistimethate sodium preferred for treatment of lower urinary tract infections because of higher urinary concentrations, including polymyxin B; use in combination with other antibiotics depending on susceptibilities

    Pregnancy Category: C

    Lactation: unknown; use caution

    Adults

    2.5-5 mg/kg/day divided q6-12hr IV/IM; not to exceed 5 mg/kg/day

    Pediatric

    Dosage expressed in terms of colistin bas

    <12 years old: Safety and efficacy not established

    Colistin

    powder for injection

    • 150mg/vial