Medically reviewed on Nov 15, 2018
(koe lis ti METH ate)
- Colistimethate Sodium
- Colistin Methanesulfonate
- Colistin Methanesulphonate
- Colistin Sulfomethate
- Pentasodium Colistin Methanesulfonate
- Polymyxin E
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution Reconstituted, Injection [preservative free]:
Coly-Mycin M: 150 mg (1 ea)
Generic: 150 mg (1 ea)
Brand Names: U.S.
- Coly-Mycin M
- Antibiotic, Miscellaneous
Colistimethate (or the sodium salt [colistimethate sodium]) is the inactive prodrug that is hydrolyzed to colistin, which acts as a cationic detergent and damages the bacterial cytoplasmic membrane causing leaking of intracellular substances and cell death
Not absorbed from the GI tract, mucous membranes, or intact skin (Note: GI absorption has been observed in infants).
Distributes widely, except for CNS, synovial, pleural, and pericardial fluids
Healthy volunteer: IV: Colistimethate: Vd: 8.92 L; Colistin: Vd: 12.4 L (Couet 2012)
Critically ill: IV: Colistimethate: Vd: 5.3 to 13.5 L; Colistin: Vd: 7.2 to 189 L (Couet 2012)
Cystic fibrosis: Adolescents and Adults: IV: Colistimethate: Vdss: 0.09 ± 0.03 L/kg (Reed 2001)
Colistimethate sodium (inactive prodrug) is hydrolyzed to colistin (active form). Note: Only ~30% of colistimethate is converted to colistin (Couet 2011)
Primarily urine (as unchanged drug)
Time to Peak
Healthy volunteers: IV: Colistin: 2 hours (range: 1 to 4 hours) (Couet 2011)
Critically ill: IV: Colistin: ~7 hours (Plachouras 2009)
IM, IV: Colistimethate: 2 to 3 hours
Critically ill: Infants (including premature infants), Children, Adolescents, and Adults: IV: Colistimethate: 2.3 hours; Colistin: 14.4 hours (Plachouras 2009)
Cystic fibrosis: IV: Colistin: ~3.5 hours (Li 2003)
ESRD patients receiving CAPD: IV: Colistin: 13.2 hours (Koomanachai 2014)
Use: Labeled Indications
Treatment of acute or chronic infections due to sensitive strains of certain gram-negative bacilli (particularly Pseudomonas aeruginosa) which are resistant to other antibacterials or in patients allergic to other antibacterials
Off Label Uses
Bronchiectasis, pulmonary colonization/infection with susceptible organisms in cystic fibrosis and noncystic fibrosis patients (nebulized)
Data from a small number of patients with bronchiectasis and severe chronic obstructive pulmonary disease with recurrent gram-negative infections demonstrated that colistimethate may improve quality of life and slow decline in FEV1 and FVC [Steinfort 2007]. A subsequent study suggested a longer time to exacerbation and improved quality of life compared to placebo [Haworth 2014]. Among patients with cystic fibrosis and early Pseudomonas aeruginosa infection, the use of nebulized antibiotics, including colistin, may eradicate the organism for up to 2 years [Langton Hewer 2017]. Additional data are necessary to further define the role of nebulized colistimethate for this indication.
Based on three studies [Conway 1997], [Conway 2000], [Ledson 1998], only one of which was randomized and controlled [Conway 1997], the use of intravenous colistimethate has demonstrated efficacy alone or in combination with an additional antipseudomonal antibiotic for the treatment of acute exacerbations of cystic fibrosis. Additional data are necessary to further define the role and dose of intravenous colistimethate for patients with cystic fibrosis.
Pneumonia, hospital-acquired or ventilator-associated due to multidrug-resistant gram-negative bacilli (eg, Pseudomonas aeruginosa or Acinetobacter baumannii [nebulized]) (alternative agent)
Based on the Infectious Diseases Society of America and the American Thoracic Society guidelines for the management of hospital-acquired and ventilator-associated pneumonia, inhaled colistimethate may be considered as an alternative adjunctive agent for patients with hospital-acquired or ventilator-associated pneumonia (VAP) caused by susceptible, multidrug-resistant (including carbapenem-resistant) gram-negative bacilli (eg, P. aeruginosa, Acinetobacter species) [IDSA [Kalil 2016]. Data from a prospective, observational, comparative study in patients with VAP caused by A. baumannii and P. aeruginosa demonstrated that the use of nebulized colistimethate was noninferior to IV beta-lactams/aminoglycosides or quinolones in patients with a sensitive strain [Lu 2012]. In addition, a meta-analysis among patients with VAP, found that adjunctive aerosolized colistimethate was associated with improved clinical cure [Valachis 2015].
Hypersensitivity to colistimethate, colistin, or any component of the formulation
Note: Dosage expressed in terms of mg of colistin base activity (CBA). CBA 1 mg is defined to be equivalent to colistimethate sodium (CMS) 30,000 units which is equivalent to ~2.4 mg CMS (see table below) (EMA 2014; Falagas 2006; Kassamali 2013; Nation 2014; Nation 2017).
Colistin-Base Activity (CBA)
Table has been converted to the following text.
Colistimethate Sodium Conversion (EMA 2014):
Colistimethate sodium 12,500 units equals
Colistimethate sodium 1 mg and equals
Colistin-base activity (CBA) 0.4 mg
Colistimethate sodium 150,000 units equals
Colistimethate sodium 12 mg and equals
Colistin-base activity (CBA) 5 mg
Colistimethate sodium 1,000,000 units equals
Colistimethate sodium 80 mg and equals
Colistin-base activity (CBA) 34 mg
Colistimethate sodium 4,500,000 units equals
Colistimethate sodium 360 mg and equals
Colistin-base activity (CBA) 150 mg
Colistimethate sodium 9,000,000 units equals
Colistimethate sodium 720 mg and equals
Colistin-base activity (CBA) 300 mg
Susceptible infections: IM, IV: 2.5 to 5 mg CBA/kg/day in 2 to 4 divided doses; maximum: 5 mg CBA/kg/day
Severe infections (due to multidrug-resistant organisms susceptible to colistin in the critically ill) (off-label dosing): IV: Loading dose: 300 mg CBA followed by 150 mg CBA twice daily (Dalfino 2012; Plachouras 2009). Additional trials may be necessary to further evaluate the use of this dosing in critically ill patients with this condition.
May also consider using the following calculations; however, although derived from critically ill patients, the use of this algorithm has not been prospectively evaluated in the critically ill. Attainment rates for the desirable target colistin concentration (2 mg/L) using these calculations in patients with creatinine clearance ≥80 mL/minute were ~40%; consider combination therapy with other antibacterials for these patients, especially for treatment of respiratory tract infection and/or for organisms with colistin MIC ≥1 mg/L (Nation 2017):
Loading dose of colistin base activity (mg) = Target average colistin steady-state plasma concentration (in mg/L) x 2 x weight (in kg). For patient weight, use the lower of ideal or actual body weight expressed in kg. Application of these equations has not been evaluated in obese patients.
Daily maintenance dose of colistin base activity (mg) = Target average colistin steady-state plasma concentration (in mg/L) x 10(0.0048 x CrCl [mL/minute] + 1.825) in 2 divided doses. Administer twice daily beginning 12 hours after loading dose. See Dosing: Renal Impairment: Adult for frequency of administration based on CrCl.
Note: Do not exceed a loading dose of 300 mg CBA or a total daily dose of 360 mg CBA due to risk of nephrotoxicity (according to this algorithm). Target Css,avg is typically 2 mg/L and should be based on MIC, site, and severity of infection. CrCl is expressed in mL/minute (Nation 2016; Nation 2017).
Bronchiectasis, pulmonary colonization/infection with susceptible organisms in cystic fibrosis and noncystic fibrosis patients (off-label use/route): Inhalation: 30 to 150 mg CBA via nebulizer 1 to 2 times daily (maximum dose: 150 mg CBA 2 times daily) (Haworth 2014; Le 2010; Sabuda 2008; Steinfort 2007). Note: An optimal dosing regimen has not been determined and varies widely among studies; lower doses have been used in noncystic fibrosis patients with bronchiectasis (Steinfort 2007).
Cystic fibrosis (off-label use): IV: 3 mg CBA/kg/day in 3 divided doses (Young 2013)
Meningitis and ventriculitis (susceptible gram-negative organisms; adjunct to systemic therapy) (use a preservative-free preparation): Intrathecal/intraventricular (off-label route): 4.2 mg CBA/day (equivalent to 10 mg CMS/day) (IDSA [Tunkel 2017]; Imberti 2012; Ziaka 2013); Note: Dose in clinical reports has ranged from 0.7 to 8.3 mg CBA/day in 1 or 2 divided doses (administered with concomitant systemic antimicrobial therapy) (Benifla 2004; De Bonis 2016; Falagas 2007; Fotakopoulos 2016; Imberti 2012; Katragkou 2005; Rodríguez Guardado 2008). When intraventricular colistimethate is administered via a ventricular drain, clamp drain for 15 to 60 minutes after administration (allows solution to equilibrate in CSF) (IDSA [Tunkel 2004]; IDSA [Tunkel 2017]). Intraventricular administration is generally reserved for use in patients who fail parenteral therapy despite removal of CSF shunt or when CSF shunt cannot be removed (Baddour 2018).
Pneumonia, hospital-acquired or ventilator-associated due to susceptible multidrug-resistant gram-negative bacilli (eg, Pseudomonas aeruginosa, Acinetobacter spp) (off-label):
Nebulization (via ventilator circuit): 150 mg CBA every 8 hours delivered over 60 minutes for 14 days or until successful wean from mechanical ventilation (treatment duration range: 7 to 19 days) (Lu 2012). May consider using as an adjunct in patients receiving IV colistin; may improve clinical outcomes (Doshi 2013; Tumbarello 2013; Valachis 2015).
IV: Loading dose: Target average colistin steady-state plasma concentration (in mg/L) x 2 x weight (in kg); use the lower of ideal or actual body weight, followed by a maintenance dose beginning 12 hours after the loading dose; the daily maintenance dose (in mg) may be calculated with the following equation: Target average colistin steady-state plasma concentration (in mg/L) x 10(0.0048 x CrCl [mL/minute] + 1.825) and administered in 2 divided doses every 12 hours based on CrCl (see Dosing: Renal Impairment: Adult) (Nation 2017). Caution is advised when administering loading doses >300 mg CBA or daily doses >360 mg CBA. Attainment rates for the desirable target colistin concentration (2 mg/L) using these calculations in patients with creatinine clearance ≥80 mL/minute were ~40%; consider combination therapy with other antibacterials for these patients with CrCl ≥80 mL/minute especially for organisms with colistin MIC ≥1 mg/L (Nation 2017). Also consider using adjunctive inhaled colistin. When used for empiric treatment of ventilator-associated pneumonia, use in combination with an agent with MRSA activity (or MSSA activity, if appropriate), with or without an additional antipseudomonal agent (dependent on risk factors) (IDSA [Kalil 2016]).
Refer to adult dosing.
Note: Dosage expressed in terms of colistin base activity (CBA); although reported conversions have varied slightly in the literature, CBA 1 mg is defined to be equivalent to colistimethate sodium (CMS) 30,000 units, which is equivalent to ~2.4 mg CMS (EMA 2014; Falagas 2006; Kassamali 2013; Nation 2017).
Susceptible infections: IM, IV: 2.5 to 5 mg CBA/kg/day in 2 to 4 divided doses; maximum: 5 mg CBA/kg/day
Dosing: Renal Impairment
Note: Dosage expressed in terms of colistin base activity (CBA); although reported conversions have varied slightly in the literature, CBA 1 mg is defined to be equivalent to colistimethate sodium (CMS) 30,000 units (Falagas 2006).
IM, IV: Adults:
CrCl ≥80 mL/minute: No dosage adjustment necessary; maximum: 5 mg CBA/kg/day
CrCl 50 to 79 mL/minute: 2.5 to 3.8 mg CBA/kg/day in 2 divided doses
CrCl 30 to 49 mL/minute: 2.5 mg CBA/kg/day once daily or in 2 divided doses
CrCl 10 to 29 mL/minute: 1.5 mg CBA/kg every 36 hours
Severe infections (due to multidrug-resistant organisms susceptible to colistin in the critically ill) (Dalfino 2012): Note: CrCl calculated using the Cockcroft-Gault equation. IV:
CrCl ≥50 mL/minute: Loading dose of 300 mg CBA followed by 150 mg CBA twice daily.
CrCl 20 to 50 mL/minute: Loading dose of 300 mg CBA followed by 150 mg CBA once daily.
CrCl <20 mL/minute: Loading dose of 300 mg CBA followed by 150 mg CBA every 48 hours.
May also consider using the following calculations; however, although derived from critically ill patients, the use of this algorithm has not been prospectively evaluated in the critically ill (Garonzik 2011):
Loading dose of colistin base activity (mg) = Target average colistin steady-state plasma concentration (in mg/L) x 2 x weight (in kg). For patient weight, use the lower of ideal or actual body weight expressed in kg. In obese patients, application of these equations has not been evaluated.
Daily maintenance dose of colistin base activity (mg) = Target average colistin steady-state plasma concentration (in mg/L) x ([1.5 x CrCl] + 30)
Note: Use caution with loading doses >300 mg CBA. Do not exceed a total daily dose of 300 mg CBA (according to this algorithm). Target Css,avg is typically 2.5 mg/L but may range from 2 to 4 mg/L (Couet 2012). Calculate CrCl using the Jellife method mL/minute/1.73 m2 or the Cockcroft-Gault method (normalized to BSA of 1.73 m2).
CrCl >70 mL/minute/1.73 m2: Administer calculated daily maintenance dose in 2 to 3 divided doses every 12 or 8 hours, respectively. Note: Unless it is appropriate to target a low colistin Css,avg, the authors do not recommended the use of these calculations in patients with CrCl >70 mL/minute/1.73 m2.
CrCl 10 to 70 mL/minute/1.73 m2: Administer calculated daily maintenance dose in 2 to 3 divided doses every 12 or 8 hours, respectively.
CrCl <10 mL/minute/1.73 m2: Administer calculated daily maintenance dose in divided doses every 12 hours.
Intermittent hemodialysis (IHD) (administer after hemodialysis on dialysis days): IV: 1.5 mg CBA/kg every 24 to 48 hours (Heintz 2009). Note: Dosing dependent on the assumption of 3 times/week, complete IHD sessions. Alternatively, may administer a daily dose of 30 mg CBA for every 1 mg/L colistin Css,avg target given in divided doses every 12 hours on nonhemodialysis days. For example, if the Css,avg target is 2.5 mg/L, then administer 37.5 mg CBA every 12 hours on nonhemodialysis days. On hemodialysis days (ideally performed at the end of the colistin dosage interval), administer a supplemental dose of 50% of the total daily dose if the supplemental dose is administered during the last half hour of the hemodialysis session or 30% of the total daily dose if the supplemental dose is administered after the hemodialysis session. These recommendations, although derived from critically ill patients, have not been prospectively evaluated in the critically ill (Garonzik 2011).
Continuous renal replacement therapy (CRRT) (Heintz 2009; Trotman 2005): Drug clearance is highly dependent on the method of renal replacement, filter type, and flow rate. Appropriate dosing requires close monitoring of pharmacologic response, signs of adverse reactions due to drug accumulation, as well as drug concentrations in relation to target trough (if appropriate). The following are general recommendations only (based on dialysate flow/ultrafiltration rates of 1 to 2 L/hour and minimal residual renal function) and should not supersede clinical judgment:
CVVH/CVVHD/CVVHDF: IV: 2.5 mg CBA/kg every 24 to 48 hours (frequency dependent upon site or severity of infection or susceptibility of pathogen). Alternatively, in patients receiving CVVH or CVVHD, may administer a daily dose of 192 mg CBA for every 1 mg/L colistin Css,avg target given in 2 to 3 equally divided doses every 12 or 8 hours, respectively (Garonzik 2011).
Note: A single case report has demonstrated that the use of 2.5 mg CBA/kg every 48 hours with a dialysate flow rate of 1 L/hour may be inadequate and that dosing every 24 hours was well-tolerated. Based on pharmacokinetic analysis, the authors recommend dosing as frequent as every 12 hours in patients receiving CVVHDF (Li 2005).
Dosing: Hepatic Impairment
There are no dosage adjustments provided in the manufacturer’s labeling.
Dosing: Adjustment for Toxicity
CNS toxicity: Dose reduction may reduce neurologic symptoms.
Nephrotoxicity: Withhold treatment if signs of renal impairment occur during treatment.
Doses should be based on ideal body weight in obese patients.
IV or IM use: Reconstitute each vial containing 150 mg of colistin base activity with 2 mL of SWFI resulting in a concentration of 75 mg colistin base activity/mL; swirl gently to avoid frothing. May further dilute in D5W or NS for IV infusion.
Intrathecal/intraventricular use (off-label route): Reconstitute with preservative-free diluent (SWFI or NS) only; use promptly after preparation; discard unused portion of vial (Quinn 2005).
Inhalation (via nebulizer; off-label route): Reconstitute vial containing 150 mg of colistin base activity with NS; further dilute dose with NS to a final concentration between 3 to 30 mg colistin base activity/mL (Maskin 2015; Yapa 2014). Optimal dosing regimens have not been determined and final concentrations used in studies vary widely; the nebulizer reservoir volume may also determine the final concentration (Berlana 2005). Storing for >24 hours may increase the risk for potential lung toxicity; preparation immediately prior to administration is recommended (FDA 2007; Le 2010, Wallace 2008); see Warnings/Precautions, Appropriate Use and Safety.
Mechanically ventilated patients: Dilute 150 mg colistin base activity with SWFI; further dilute dose with 10 mL SWFI to a final concentration of 15 mg colistin base activity/mL (Lu 2012).
Parenteral: Administer by IM, direct IV injection over 3 to 5 minutes, intermittent infusion over 30 minutes (Beringer 2001; Conway, 1997), or by continuous IV infusion (according to the manufacturer). For continuous IV infusion, one-half of the total daily dose is administered by direct IV injection over 3 to 5 minutes followed 1 to 2 hours later by the remaining one-half of the total daily dose diluted in a compatible IV solution infused over 22 to 23 hours. The final concentration for continuous infusion administration should be based on the patient's fluid needs; infusion should be completed within 24 hours of preparation.
Inhalation (off-label route): Administer solution via nebulizer (vibrating plate nebulizer may be preferred [Lu 2012]) promptly following preparation to decrease possibility of high concentrations of colistin from forming which may lead to potentially life-threatening lung toxicity. Consider use of a bronchodilator (eg, albuterol) within 15 minutes prior to administration (Le 2010). If patient is on a ventilator, place medicine in a T-piece at the midinspiratory circuit of the ventilator. One study in adult patients with VAP administered colistimethate over 60 minutes using a vibrating plate nebulizer positioned on the inspiratory limb 10 cm proximal to the Y-piece (Lu 2012).
Note: A case report of fatal lung toxicity implicated in vitro colistin formation from an inhalation solution as a potential etiology, but data regarding the concentration, formulation and storage of the inhaled colistin administered to the patient were not reported (FDA 2007; McCoy 2007; Wallace 2008). An acceptable limit of in vitro colistin formation to prevent potential toxicity is unknown. Limited stability data are available regarding the storage of colistin solution for inhaled administration (Healan 2012; Wallace 2008). Storing for >24 hours may increase the risk for potential lung toxicity; preparation immediately prior to administration is recommended (FDA 2007; Le 2010, Wallace 2008).
Intrathecal/intraventricular (off-label route): Administer only preservative-free solutions via intrathecal/intraventricular routes. Administer promptly after preparation. Discard unused portion of vial. When administered through a ventricular drain, clamp drain for 15 to 60 minutes before opening the drain to allow colistimethate solution to equilibrate in the CSF (IDSA [Tunkel 2004]; IDSA [Tunkel 2017]).
Store intact vials (prior to reconstitution) at 20°C to 25°C (68°F to 77°F); excursions permitted to 15°C to 30°C (59°F to 86°F). Reconstituted vials may be refrigerated at 2°C to 8°C (36°F to 46°F) or stored at 20°C to 25°C (68°F to 77°F) for up to 7 days. Solutions for infusion should be freshly prepared in D51/4NS, D51/2NS, D5NS, D5W, LR, or NS; do not use beyond 24 hours.
Aminoglycosides: May enhance the nephrotoxic effect of Colistimethate. Aminoglycosides may enhance the neuromuscular-blocking effect of Colistimethate. Consider therapy modification
Amphotericin B: May enhance the nephrotoxic effect of Colistimethate. Consider therapy modification
Bacitracin (Systemic): Colistimethate may enhance the nephrotoxic effect of Bacitracin (Systemic). Avoid combination
BCG (Intravesical): Antibiotics may diminish the therapeutic effect of BCG (Intravesical). Avoid combination
BCG Vaccine (Immunization): Antibiotics may diminish the therapeutic effect of BCG Vaccine (Immunization). Monitor therapy
Capreomycin: May enhance the neuromuscular-blocking effect of Colistimethate. Monitor therapy
Cefazedone: May enhance the nephrotoxic effect of Colistimethate. Monitor therapy
Cephalothin: May enhance the nephrotoxic effect of Colistimethate. Monitor therapy
Cholera Vaccine: Antibiotics may diminish the therapeutic effect of Cholera Vaccine. Management: Avoid cholera vaccine in patients receiving systemic antibiotics, and within 14 days following the use of oral or parenteral antibiotics. Avoid combination
Lactobacillus and Estriol: Antibiotics may diminish the therapeutic effect of Lactobacillus and Estriol. Monitor therapy
Mecamylamine: Colistimethate may enhance the neuromuscular-blocking effect of Mecamylamine. Avoid combination
Methoxyflurane: Colistimethate may enhance the nephrotoxic effect of Methoxyflurane. Avoid combination
Neuromuscular-Blocking Agents: Colistimethate may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Consider therapy modification
Polymyxin B: May enhance the neuromuscular-blocking effect of Colistimethate. Monitor therapy
Sodium Picosulfate: Antibiotics may diminish the therapeutic effect of Sodium Picosulfate. Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in patients who have recently used or are concurrently using an antibiotic. Consider therapy modification
Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Management: Vaccination with live attenuated typhoid vaccine (Ty21a) should be avoided in patients being treated with systemic antibacterial agents. Use of this vaccine should be postponed until at least 3 days after cessation of antibacterial agents. Consider therapy modification
Vancomycin: May enhance the nephrotoxic effect of Colistimethate. Consider therapy modification
Genitourinary: Nephrotoxicity (18% to 26% [Dalfino 2012; Oliveira 2009])
Renal: Acute renal failure (33% to 60% [Akajagbor 2013; Deryke 2010])
1% to 10%:
Central nervous system: Neurotoxicity (7%; higher incidence with high-dose IV use in cystic fibrosis [Bosso 1991; Koch-Weser 1970])
Frequency not defined:
Central nervous system: Dizziness, oral paresthesia, paresthesia, peripheral paresthesia, seizures, slurred speech, vertigo
Dermatologic: Pruritus, skin rash, urticaria
Gastrointestinal: Clostridioides (formerly Clostridium) difficile-associated diarrhea, gastric distress
Genitourinary: Decreased urine output
Renal: Decreased creatinine clearance, increased blood urea nitrogen, increased serum creatinine
Respiratory: Apnea, respiratory distress
Concerns related to adverse effects:
• Bronchoconstriction: Use of inhaled colistimethate (off-label route) may result in bronchoconstriction. Use with caution in patients with hyperactive airways; consider administration of a bronchodilator (eg, albuterol) within 15 minutes prior to administration (Le 2010).
• CNS toxicity: Transient, reversible neurological disturbances (eg, dizziness, numbness, paresthesia, generalized pruritus, slurred speech, tingling, vertigo) may occur. Patients must be cautioned about performing tasks which require mental alertness (eg, operating machinery or driving). Dose reduction may reduce neurologic symptoms; monitor closely.
• Renal toxicity: Dose-dependent nephrotoxicity has been reported, generally reversible upon discontinuation of treatment. Withhold treatment if signs of renal impairment occur during treatment.
• Respiratory arrest: Respiratory arrest has been reported with use; impaired renal function may increase the risk for neuromuscular blockade and apnea.
• Superinfection: Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment.
• Renal impairment: Use with caution in patients with preexisting renal impairment; dosage adjustments are recommended. Impaired renal function may increase the risk for respiratory arrest.
Concurrent drug therapy issues:
• Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information.
• Appropriate use: Inhalation (off-label route): Once mixed, colistimethate begins conversion to bioactive colistin, a component of which may result in severe pulmonary toxicity (Le 2010). Solutions for inhalation must be mixed immediately prior to administration and used within 24 hours to reduce the incidence of pulmonary toxicity.
• Appropriate use: IV: Use only to prevent or treat infections strongly suspected or proven to be caused by susceptible bacteria to minimize development of bacterial drug resistance.
• Safety: Potential for dosing errors due to lack of standardization in literature when referring to product and dose; colistimethate (inactive prodrug) and colistin base strengths are not interchangeable; verify prescribed dose is expressed in terms of colistin base activity prior to dispensing.
Serum creatinine, BUN; urine output; signs of neurotoxicity; signs of bronchospasm (inhalation [off-label route])
Pregnancy Risk Factor
Adverse events have been observed in animal reproduction studies. Colistimethate crosses the placenta in humans.
• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
• Patient may experience diarrhea or nausea. Have patient report immediately to prescriber signs of kidney problems (urinary retention, hematuria, change in amount of urine passed, or weight gain), burning or numbness feeling, slurred speech, dizziness, passing out, seizures, muscle weakness, difficulty breathing, slow breathing, shallow breathing, or signs of Clostridium difficile (C. diff)-associated diarrhea (abdominal pain or cramps, severe diarrhea or watery stools, or bloody stools) (HCAHPS).
• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.
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Other brands: Coly Mycin M