KEY POINTS
- Colistimethate sodium is an inactive prodrug which converts to colistin (the active component) in the body
- Colistin is also known as polymyxin E
- Works as a cationic detergent, damaging bacterial cytoplasmic membrane and causing leakage of intracellular contents
- Available as injectable and injectable is at times given via inhalation
- Only used for Gram negative bacteria, like Pseudomonas aeruginosa and Acinetobacter baumannii
- A last-line antibiotic and is typically only used when few to no other options exist
- Highly associated with nephrotoxicity
- Associated with neurotoxicity
RESOURCES
- Colistin Package Insert
- Polymyxins: antibacterial activity, susceptibility testing, and resistance mechanisms encoded by plasmids or chromosomes (CMR 2017)
- Low doses of colistin: don’t rush in! (CID, 2017)
- Polymyxin monotherapy or in combination against carbapenem-resistant bacteria: systematic review and meta-analysis (JAC, 2016)
- Nephrotoxicity of polymyxins: is there any difference between colistimethate and polymyxin B? (AAC, 2016)
- Colistin: understanding and applying recent pharmacokinetic advances (Pharmacotherapy, 2015)
- Variability within investigations of intravenous colistin: the scope of the problem (CID, 2014)
- Updated US and European Dose Recommendations for Intravenous Colistin: How Do They Perform? (CID, 2016)
- Colistin and polymyxin B: peas in a pod, or chalk and cheese? (CID, 2014)
- Consistent global approach on reporting of colistin doses to promote safe and effective use (CID, 2014)
- Inhaled colistin FDA warning
- Colistin dosing tool