Colistimethate (Colistin)

Dosing

Defined criteria for use and/or important safety considerations. See below for more information.

  • Loading dose 4mg/kg (use lower of ideal or actual body weight) start maintenance dose 12 hours later

  • Dosing recommendations continue to evolve.

  • At present there are 3 sources for dosing guidance and all are listed below.

  • The preferred dosing is from the PK Study group and is listed first.

CrCl greater than or equal to 90 mL/minCrCl 80 - < 90 mL/minCrCl 70 - < 80 mL/minCrCl 60 - <70 mL/minCrCl 50 - < 60 mL/minCrCl 40 - < 50 mL/minCrCl 30 - < 40 mL/minCrCl 20 - < 30 mL/minCrCl 10 - < 20 mL/minCrCl 5 - <10 mL/minCrCl < 5 mL/minClin Infect Dis 2017;64:565180 mg BID170 mg BID150 mg BID140 mg BID125 mg BID110 mg BID100 mg BID90 mg BID80 mg BID75 mg BID65 mg BID

CrCl greater than or equal to 50 mL/minCrCl 30 - < 50 mL/minCrCl 10 - < 30 mL/minCrCl < 10 mL/minClin Infect Dis 2016; 62:552150 mg BID95 - 125 mg BID75 - 95 mg BID60 mg BID

CrCl greater than or equal to 80 mL/minCrCl 50 - < 80 mL/minCrCl 30 - < 50 mL/minCrCl 10 - < 30 mL/minBased on package insert1.25 - 2.5 mg/kg BID1.25 - 1.9 mg/kg BID2.5 mg/kg once daily or 1.25 mg/kg BID1.5 mg/kg q36h

General Information

Used as an alternative in multi-drug resistant infections, primarily carbapenem-resistant microorganisms.

Always use in combination with a carbapenem regardless of in vitro carbapenem susceptibility

Resistant

  • Burkholderia cepacia

  • Serratia marcescens

  • Moraxella catarrhalis

  • Proteus spp, Providencia spp

  • Morganella morganii

CNS toxicity

  • Self-limiting and reversible neurological disturbances may occur

  • Numbness

  • Vertigo

  • Paresthesia

  • Generalized pruritus

  • Tingling

  • Slurred speech

  • Dose reduction may reduce neurologic symptoms.

Renal toxicity

Respiratory arrest

  • Impaired renal function might increase the risk for neuromuscular blockade

  • CNS toxicity: Self-limiting and reversible neurological disturbances may occur: numbness, vertigo, paresthesia, generalized pruritus, tingling and slurred speech. Dose reduction may reduce neurologic symptoms.

  • Renal toxicity

  • Respiratory arrest: impaired renal function might increase the risk for neuromuscular blockade

Dosage is based on mg of colistin base activity (CBA). Some products are labeled in international units. To convert: 1mg CBA = 30,000 IU CMS (Colistimethate) 33 mg CBA = 1,000,000 IU CMS 1 mg CBA = 2.4 mg CMS

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