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
- International Consensus Guidelines for the Optimal Use of the Polymyxins: Endorsed by the American College of Clinical Pharmacy (ACCP), European Society of Clinical Microbiology and Infectious Diseases (ESCMID), Infectious Diseases Society of America (IDSA), International Society for Anti‐infective Pharmacology (ISAP), Society of Critical Care Medicine (SCCM), and Society of Infectious Diseases Pharmacists (SIDP). Pharmacotherapy. 2019.
- 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