Colistin


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : PO GI infections; Bowel sterilisation As colistin sulfate: 1.5-3 MIU tid. IV/IM Severe Gram-ve infections As colistimethate Na (strength expressed in terms of colistin base): 2.5-5 mg/kg/day in 2-4 divided doses. Max: 5 mg/kg/day.
Dosage Details
Oral
Bowel sterilisation, Gastrointestinal infections
Adult: As colistin sulfate: 1.5-3 MIU tid.
Child: As colistin sulfate: <15 kg: Not suitable; 15-30 kg: 0.75-1.5 MIU tid.

Parenteral
Severe Gram-negative infections
Adult: As colistimethate Na (strength expressed in terms of colistin base): 2.5-5 mg/kg/day in 2-4 divided doses. Max: 5 mg/kg/day.
Child: As colistimethate Na (strength expressed in terms of colistin base): 2.5 mg/kg/day divided 6-12 hrly.
Renal Impairment
Parenteral:
 CrCl (mL/min) Dosage 
 10-29 1.5 mg/kg 36hrly. 
 30-49 2.5 mg/kg/day once daily or in 2 divided doses. 
 50-79 2.5-3.8 mg/kg/day in 2 divided doses. 
 ≥80 Same as adult dose. 
Reconstitution
Reconstitute 150 mg vial w/ 2 mL sterile water for inj. Reconstituted soln provides colistimethate Na at a concentration equivalent to 75 mg/mL colistin base.
Contraindications
Hypersensitivity. Myasthenia gravis.
Special Precautions
Patients w/ renal impairment, porphyria. Pregnancy and lactation.
Adverse Reactions
Superinfection; renal damage; visual disturbances; GI disturbances, dizziness, nausea, vomiting; confusion, peripheral neuropathy; respiratory insufficiency and muscle weakness.
Potentially Fatal: Severe colitis.
Patient Counseling Information
Due to neurologic disturbances that may occur, if affected, do not drive or operate machinery.
MonitoringParameters
Monitor serum creatinine and BUN regularly while on treatment.
Overdosage
Symptoms: Signs of neuromuscular blockade e.g. paraesthesia, lethargy, confusion, ataxia, dizziness, apnoea. Possible respiratory arrest and acute renal failure. Management: Supportive treatment and steps to increase elimination rate of colistin e.g. mannitol diuresis, prolonged haemodialysis or peritoneal dialysis.
Drug Interactions
Potentiates action of curariform muscle relaxants. Increased nephrotoxicity w/ aminoglycosides, amphotericin B, capreomycin, vancomycin.
Action
Description: Colistin is a polymyxin antibiotic which is active against aerobic gram-ve bacteria including most enterobacteria except Proteus, Providentia and Serratia. Susceptible organisms include P. aeruginosa, Legionella spp, H. influenzae, Acinetobacter, V. cholera, Salmonella, Shigella and Pasteurella. It acts as a cationic detergent that causes leaking of intracellular substances and cell death by damaging the bacterial cytoplasmic membrane.
Pharmacokinetics:
Absorption: Poorly absorbed from the GI tract. Time to peak plasma concentration: 2-3 hr (IM).
Distribution: Reversibly bound to body tissues; diffuses across the placenta but negligible into the CSF except in infants. Enters breast milk.
Excretion: More rapid in childn than in adults; diminished in patients with renal impairment.
Chemical Structure

Chemical Structure Image
Colistin

Source: National Center for Biotechnology Information. PubChem Database. Colistin, CID=5311054, https://pubchem.ncbi.nlm.nih.gov/compound/Colistin (accessed on Jan. 22, 2020)

Storage
Store between 20-25°C. Reconstituted soln: Store between 2-8°C.
MIMS Class
References
Anon. Colistin (Colistimethate) . Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 11/08/2015.

Buckingham R (ed). Colistin Sulfate . Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 11/08/2015.

Colistimethate for Injection (JHP Pharmaceuticals, LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 11/08/2015.

McEvoy GK, Snow EK, Miller J et al (eds). Colistimethate Sodium. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 11/08/2015.

Disclaimer: This information is independently developed by MIMS based on Colistin from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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