Antimicrobials
Colistin

Colistin

C difficile risk
Low
Oral Bioavailability
N/A
Cost
See below under General Info

Dosing

Dosed in colistin base:

Critically Ill 300 mg IV load, then 150 mg IV q12h or 2.5-5 mg IV daily (divided q12h)

Cystic Fibrosis 3 mg/kg/day in 3 divided doses

0 - 10 eGFR10 - 50 eGFR50+ eGFR150 mg IV q36h, or if less than 60 kg, 1.5-2.5 mg/kg IV q36h150 mg IV q24h, or if less than 60 kg, 2.5 mg/kg IV q24h150 mg IV q12h, , or if less than 60 kg, 2.5 mg/kg IV q12h

On days with no HD, give 52.5 mg IV q12h; on dialysis days, give 75 mg IV during last hour of dialysis and 75 mg 12 hours later

150 mg IV q24h, or if less than 60 kg, 2.5 mg/kg IV q24h

General Information

Hospital Formulary Status Yes (parenteral inj)

In-Hospital Cost will be updated

PharmaCare Formulary Status Yes (parenteral inj)

Special Authority None

PharmaCare Coverage 150mg powder for soln/inj - $35.2800/vial

Outpatient Cost 150mg powder for soln/inj - $35.28-40.69/vial

Infections caused by Carbapenemase-producing organisms.

Renal function

Nephrotoxicity (IV)

  • sx: hematuria, proteinuria and oliguria

  • associated with reversible acute renal failure due to acute tubular necrosis

  • higher rate of nephrotoxicity than polymyxin B

  • SCr may increase by 0.25 mg/dL (22 micromol/L) during treatment but usually returns close to baseline at the end of treatment

Neurotoxicity (IV)

  • sx: dizziness, weakness, facial and peripheral paresthesia, vertigo, visual disturbances, confusion, ataxia, psychosis, coma, convulsions, ptosis, diplopia, areflexia, dysphagia, dysphonia and neuromuscular blockade, which can lead to respiratory failure or apnea

  • neuromuscular blockade is due to noncompetitive blockade that is not reversed by neostigmine

  • can occur within 4 days of initiation

  • more common in women and patients with cystic fibrosis

  • usually reversible and resolves after discontinuation

Hypersensitivity reactions (IV)

  • sx: rash, pruritus, urticaria and fever

Nephrotoxins.

Concurrent use or pre-administration of other neuromuscular blocking agents, which can interfere with neuromuscular function.

Antimicrobial class: Cationic Detergent

Avoid in myasthenia gravis.

Average serum half life: 2.5 hr

CSF penetration: No