Colistimethate

General
  • Type: Antibiotic
  • Dosage Forms: IV
  • Common Trade Names:

Adult Dosing
  • 2.5-5 mg/kg/day divided q6-12hr IV/IM; not to exceed 5 mg/kg/day

Pediatric Dosing
  • <12yo: safety/efficacy not established

Special Populations
  • Pregnancy Rating: C
  • Lactation: Unknown, use caution
  • Renal Dosing
    • CrCl 50-79 mL/min: 2.5-3.8 mg/kg/day IV/IM divided q12hr
    • CrCl 30-49 mL/min: 2.5 mg/kg/day IV/IM qDay or divided q12hr
    • CrCl 10-29 mL/min: 1.5 mg/kg IV/IM q36hr
  • Hepatic Dosing: Not established

Contraindications
  • Allergy to class/drug

Adverse Reactions

Serious
  • Anaphylaxis
  • Acute respiratory failure, particularly in myasthenia gravis or recent use of NMJ blockade
  • Nephrotoxicity
  • Neurotoxicity, seizures
  • C. diff pseudomembranous colitis

Common
  • Dizziness
  • Paresthesias
  • Dysarthria

Pharmacology
  • Half-life: 2-3h
  • Metabolism:
  • Excretion: Urine
  • Mechanism of Action: "Cationic detergent that damages bacterial cytoplasmic membrane, causing cell death"[1]

Antibiotic Sensitivities[2]
Group Organism Sensitivity
Gram PositiveStrep. Group A, B, C, GR
Strep. PneumoniaeR
Viridans strepX1
Strep. anginosus gpX1
Enterococcus faecalisR
Enterococcus faeciumR
MSSAR
MRSAR
CA-MRSAR
Staph. EpidermidisR
C. jeikeiumR
L. monocytogenesR
Gram NegativesN. gonorrhoeaeR
N. meningitidisR
Moraxella catarrhalisX1
H. influenzaeX1
E. coliS
Klebsiella spS
E. coli/Klebsiella ESBL+S
E coli/Klebsiella KPC+S
Enterobacter sp, AmpC negS
Enterobacter sp, AmpC posS
Serratia spX1
Serratia marcescensR
Salmonella spX1
Shigella spX1
Proteus mirabilisX1
Proteus vulgarisR
Providencia sp.X1
Morganella sp.X1
Citrobacter freundiiX1
Citrobacter diversusX1
Citrobacter sp.X1
Aeromonas spX1
Acinetobacter sp.S
Pseudomonas aeruginosaS
Burkholderia cepaciaR
Stenotrophomonas maltophiliaI
Yersinia enterocoliticaX1
Francisella tularensisX1
Brucella sp.X1
Legionella sp.X1
Pasteurella multocidaX1
Haemophilus ducreyiX1
Vibrio vulnificusX1
MiscChlamydophila spX1
Mycoplasm pneumoniaeX1
Rickettsia spX1
Mycobacterium aviumX1
AnaerobesActinomycesX1
Bacteroides fragilisX1
Prevotella melaninogenicaX1
Clostridium difficileX1
Clostridium (not difficile)X1
Fusobacterium necrophorumX1
Peptostreptococcus sp.X1

Key
  • S susceptible/sensitive (usually)
  • I intermediate (variably susceptible/resistant)
  • R resistant (or not effective clinically)
  • S+ synergistic with cell wall antibiotics
  • U sensitive for UTI only (non systemic infection)
  • X1 no data
  • X2 active in vitro, but not used clinically
  • X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
  • X4 active in vitro, but not clinically effective for strep pneumonia

See Also

References
  1. https://reference.medscape.com/drug/colistimethate-sodium-coly-mycin-m-colistin-342578#10
  2. Sanford Guide to Antimicrobial Therapy 2014
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