colistin

Colistin is an antibiotic used to treat acute and chronic bacterial infections from susceptible strains of certain gram-negative bacteria. Gram-negative bacteria have an additional cell membrane that gram-positive bacteria lack, and they can be identified by whether they get dyed or not in the Gram stain lab test.

Colistin belongs to the polymyxin class of antibiotics and is the last line of defense against serious multidrug resistant infections. It is administered through an intravenous (IV) or intramuscular (IM) injection. Colistin binds to gram-negative bacteria’s fatty cell membranes, causing leakage of cell contents and bacterial cell death.

Colistin has a narrow spectrum of activity limited to certain gram-negative bacteria and is ineffective against gram-positive bacteria. Gram-negative bacteria susceptible to colistin include:

• Pseudomonas aeruginosa
• Acinetobacter baumannii
• Haemophilus influenzae
• Bordetella pertussis
• Legionella pneumophila
• Salmonella species
• Shigella species
• Majority of Stenotrophomonas maltophilia strains
• Carbapenem-resistant Enterobacteriaceae including
• Escherichia coli
• Klebsiella pneumoniae
• Some Enterobacter species

Warnings

• Do not use to treat patients with a history of hypersensitivity to colistin or any of its components.
• Inhaled colistimethate (off-label route) may result in bronchoconstriction. Use with caution in patients with hyperactive airways. Consider administration of a bronchodilator such as albuterol prior to colistin.
• Colistin is toxic to the central nervous system and may cause temporary neurological disturbances such as tingling, numbness, dizziness, vertigo, and slurred speech. Advise patients to avoid activities that require mental alertness.
• Colistin is toxic to the kidneys. Discontinue therapy if signs of impaired kidney function occur.
• Respiratory arrest has been reported with colistin use. Use with caution in patients with kidney disease and myasthenia gravis and avoid concurrent use of anesthetics or other neuromuscular blocking drugs.
• Prolonged colistin use may cause fungal or bacterial superinfection, including colon inflammation (pseudomembranous colitis) and Clostridium difficile-associated diarrhea (CDAD).

Side effects of colistin

Common side effects of colistin include:

• Central nervous system effects including: dizziness, numbness and prickling sensation of skin (paresthesia), tingling of extremities and tongue, seizures, slurred speech, and vertigo.

Less common side effects of colistin include:

• Gastrointestinal upset
• Clostridium difficile-associated diarrhea
• Fever
• Skin rash
• Hives (urticaria)
• Itching (pruritus)
• Severe hypersensitivity reaction (anaphylaxis)
• Respiratory distress
• Pause in breathing (apnea)
• Acute respiratory failure ((inhalation route)
• Acute kidney failure

This is not a complete list of all side effects or adverse reactions that may occur from the use of this drug.

Call your doctor for medical advice about serious side effects or adverse reactions. You may also report side effects or health problems to the FDA at 1-800-FDA-1088.

Dosages of colistin

Powder for Injection

Susceptible Infections

Adult and pediatric patients older than 12 years of age

Children under 12 years of age: Safety and efficacy not established

Dosage expressed in terms of colistin base

• 2.5-5 mg/kg/day divided every 6-12 hours intravenously/intramuscularly (IV/IM); not to exceed 5 mg/kg/day

Dosage Modifications

• CrCl greater than 80 mL/minute: No dosage adjustment required
• CrCl 50-79 mL/minute: 2.5-3.8 mg/kg/day IV/IM divided every 12 hours
• CrCl 30-49 mL/minute: 2.5 mg/kg/day IV/IM once daily or divided every 12 hours
• CrCl 10-29 mL/minute: 1.5 mg/kg IV/IM every 36 hours

Other Indications and Uses

• Gram-negative infection (e.g., Enterobacter aerogenes, E. coli, Klebsiella, Pseudomonas) unresponsive to other antibiotics
• Multi-drug resistant gram-negative infection

Overdose

• Colistin overdose may cause neuromuscular adverse effects such as ataxia, paresthesia, lethargy, dizziness, and confusion.
• Severe overdose can cause acute kidney failure, respiratory paralysis, and death.
• Colistin overdose is treated with symptomatic and supportive care.

Drug interactions

Inform your doctor of all medications you are currently taking to avoid any possible drug interactions. Never begin or stop any medication without your doctor’s recommendation.

• Colistin has no known severe interactions with other drugs.
• Serious interactions of colistin include:
• amphotericin B deoxycholate
• atracurium
• bacitracin
• choleravaccine
• cidofovir
• cisatracurium
• neomycin PO
• onabotulinumtoxinA
• pancuronium
• rapacuronium
• rocuronium
• succinylcholine
• vecuronium
• abobotulinumtoxinA
• acyclovir
• amikacin
• cisplatin
• iodinated contrast media
• cyclosporine
• elvitegravir/cobicistat/emtricitabine/tenofovir DF
• gentamicin
• ioversol
• polymyxin B
• sodium picosulfate/magnesium oxide/anhydrous citric acid
• streptozocin
• tacrolimus
• tenofovir DF
• tobramycin
• voclosporin
• adefovir
• foscarnet
• methoxyflurane
• oxaliplatin
• paromomycin
• pentamidine
• streptomycin
• vancomycin

The above list does not include all possible interactions or adverse effects. For more information on drug interactions, visit the RxList Drug Interaction Checker.

Always inform your doctor, pharmacist, or healthcare provider of all prescription and over-the-counter medications you use, as well as the dosage for each, and keep a list of this information. Check with your doctor or healthcare provider if you have any questions about the medication.

Pregnancy and breastfeeding

• No adequate and well-controlled studies on colistin use in pregnant women, and animal studies show evidence of fetal harm. Use during pregnancy only if potential benefits outweigh potential risks to the fetus.
• Colistin is excreted in breast milk. Use with caution in nursing mothers.

Other important information

• Diarrhea is a common problem with antibiotic treatments. If you have watery or bloody stools, with or without stomach cramps and fever, seek medical help. Symptoms can develop up to two months after the last dose of antibiotic.
• Colistin may impair mental and physical abilities. Do not engage in activities such as driving or operating heavy machinery.

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Summary

Colistin is an antibiotic used to treat acute and chronic bacterial infections from susceptible strains of certain gram-negative bacteria. It is toxic to the kidneys. Discontinue therapy if signs of impaired kidney function occur. Common side effects include dizziness, paresthesia, seizures, slurred speech, and decreased urine output.