Adult Dosing
Susceptible gram-negative bacilli infections
- 2.5-5 mg/kg/day IM/IV divided q6-12 hrs
- Max: 5 mg/kg/day
Pediatric Dosing
Susceptible gram-negative bacilli infections
- 2.5-5 mg/kg/day IM/IV divided q6-12 hrs
- Max: 5 mg/kg/day
[Outline]
Renal Dose Adjustment (Based on serum creatinine)
- Cr 1.3-1.5 mg/dL: 2.5-3.8 mg/kg/day div q12 hrs
- Cr 1.6-2.5 mg/dL: 2.5 mg/kg/day div q12-24 hrs
- Cr > 2.6-4 mg/dL: 1.5 mg/kg q36 hrs
- Hemodialysis: Not defined
Hepatic Dose Adjustment
- Hepatic impairment: Dose adjustments not defined
Obese individuals
- Dose on ideal body weight
See Supplemental Patient Information
- To reduce the development of drug-resistant bacteria, colistimethate should be used only to treat or prevent infections that are proven or strongly suspected to be caused by bacteria
- Dose should be limited to 5 mg/kg/day (2.3 mg/lb) with normal renal function
- Neurological disturbances may occur, so patients should be refrained from driving vehicles and use of hazardous machinery and monitor the patients with outmost care
- Dose-dependent nephrotoxicity can occur, it can be reversed after discontinuation of the antibiotic
- Renal insufficiency, muscle weakness, and apnea may occur on overdosage
- Respiratory arrest has been reported with intramuscular administration of colistimethate sodium
- Dose adjustment is necessary for impaired renal function
- Clostridium difficile associated diarrhea (CDAD) ranging from mild diarrhoea to fatal colitis is associated with all antibacterial agent
- Appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C. difficile, and surgical evaluation should be done
- Antibiotic therapy alters the normal flora of the colon resulting in overgrowth of C. difficile, which cause increased morbidity and mortality , as these infections can be unmanageable to antimicrobial therapy and may require colectomy
- CDAD may occur over two months after the administration of antibacterial agents hence medical history of patients is necessary
Cautions: Use cautiously in
- Renal impairment (refer dose adjustment section)
- Nephrotoxic agent use
- Neuromuscular disease
- Neurotoxic agent use
Supplemental Patient Information
- Do not use to treat viral infections like common cold
- Incomplete doses or skipping doses decrease the effectiveness of the treatment and increases bacterial resistance; advise patients to adhere to dosing regimen
- Advise patients to contact physician in event of occurence of watery and bloody stools
Pregnancy Category:C
Breastfeeding: Safety unknown; limited data indicate that colistin is minimally excreted into breastmilk following IM administration of colistimethate. This information is based upon LactMed database http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 16 November 2010). Manufacturer advises caution
