Colistimethate Colistin Polymyxin E

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Colistimethate Colistin Polymyxin E Brand Name– Coly-Mycin M

What is Colistimethate Colistin Polymyxin E

Colistin also known as polymyxin E, is a polypeptide antibiotic.

Colistin is bactericidal and used in the treatment of infections caused by gram-negative bacteria, with a particular focus on multidrug-resistant organisms such as Pseudomonas aeruginosaAcinetobacter baumannii, and Klebsiella pneumoniae.

There are 2 formulations of colistin available.

Colistin sulfate (also known as colistin base) is available in topical otic combination products.

Colistimethate sodium, the parenteral product, is a prodrug and is inactive until it is hydrolyzed in vivo to form a mixture of partially sulfomethylated derivatives and colistin; hydrolysis also occurs in aqueous solutions.

Colistimethate sodium can be administered intravenously or intramuscularly and is also used off-label intrathecally and intraventricularly for meningitis and ventriculitis.

Colistimethate sodium injection is also used off-label as a nebulized solution for the treatment of pneumonia and for management of infection in cystic fibrosis (CF) patients.

With the emergence of multidrug-resistant gram-negative pathogens and the shrinking pipeline of new antibacterial agents, colistin has reemerged as a systemic option for difficult-to-treat gram-negative infections.

Due to the decades of limited colistin use, updated data on spectrum of activity, dosing, pharmacokinetics, and toxicity are deficient.

Despite a lack of controlled trials to further define these to date, colistin is often used in the setting where no other therapies are available. This drug was FDA-approved in 1968.

Indications

  1. Acinetobacter baumannii
  2. Acinetobacter sp.
  3. Citrobacter sp.
  4. cystic fibrosis
  5. Enterobacter sp.
  6. Escherichia coli
  7. gram-negative infection
  8. Haemophilus influenzae (beta-lactamase negative)
  9. Haemophilus influenzae (beta-lactamase positive)
  10. Klebsiella aerogenes
  11. Klebsiella pneumoniae
  12. meningitis
  13. Morganella morganii
  14. Mycobacterium fortuitum
  15. Mycobacterium intracellulare
  16. Mycobacterium phlei
  17. Mycobacterium smegmatis
  18. Mycobacterium tuberculosis
  19. Mycobacterium xenopi
  20. nosocomial pneumonia
  21. Pseudomonas aeruginosa
  22. Salmonella sp.
  23. Shigella sp.
  24. Stenotrophomonas maltophilia
  25. ventriculitis
  26. Yersinia pseudotuberculosis
  27. Yersinia sp.

Side Effects

  1. anaphylactoid reactions
  2. anuria
  3. apnea
  4. ataxia
  5. bronchospasm
  6. candidiasis
  7. confusion
  8. cough
  9. cylindruria
  10. diarrhea
  11. dizziness
  12. dysarthria
  13. fever
  14. hallucinations
  15. hearing loss
  16. hematuria
  17. myopathy
  18. oliguria
  19. paresthesias
  20. proteinuria
  21. pruritus
  22. pseudomembranous colitis
  23. psychosis
  24. rash
  25. renal failure (unspecified)
  26. renal tubular necrosis
  27. respiratory arrest
  28. seizures
  29. superinfection
  30. throat irritation
  31. urticaria
  32. vertigo
  33. weakness

Monitoring Parameters

  • serum creatinine/BUN: in chronic use or acute toxicity

Contraindications

  • asthma
  • breast-feeding
  • chronic obstructive pulmonary disease (COPD)
  • colitis
  • diarrhea
  • driving or operating machinery
  • GI disease
  • inflammatory bowel disease
  • myasthenia gravis
  • neurological disease
  • neuromuscular disease
  • polymyxin hypersensitivity
  • pregnancy
  • pseudomembranous colitis
  • pulmonary disease
  • renal disease
  • renal failure
  • renal impairment
  • ulcerative colitis

Interactions

  • AbobotulinumtoxinA
  • Acyclovir
  • Amikacin
  • Aminoglycosides
  • Amphotericin B
  • Amphotericin B cholesteryl sulfate complex (ABCD)
  • Amphotericin B lipid complex (ABLC)
  • Amphotericin B liposomal (LAmB)
  • Bacitracin
  • Bictegravir; Emtricitabine; Tenofovir Alafenamide
  • Botulinum Toxins
  • Bupivacaine; Lidocaine
  • Capreomycin
  • Carboplatin
  • Cidofovir
  • Cisplatin
  • Clindamycin
  • Cyclosporine
  • Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
  • Dextromethorphan; Quinidine
  • Doravirine; Lamivudine; Tenofovir disoproxil fumarate
  • Efavirenz; Emtricitabine; Tenofovir
  • Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
  • Emtricitabine; Rilpivirine; Tenofovir alafenamide
  • Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
  • Emtricitabine; Tenofovir alafenamide
  • Emtricitabine; Tenofovir disoproxil fumarate
  • Enflurane
  • Entecavir
  • Etomidate
  • Foscarnet
  • Fospropofol
  • Ganciclovir
  • General anesthetics
  • Gentamicin
  • Halothane
  • Hyaluronidase, Recombinant; Immune Globulin
  • Immune Globulin IV, IVIG, IGIV
  • IncobotulinumtoxinA
  • Isoflurane
  • Kanamycin
  • Ketamine
  • Lamivudine; Tenofovir Disoproxil Fumarate
  • Lidocaine
  • Lithium
  • Methohexital
  • Neuromuscular blockers
  • Non-Ionic Contrast Media
  • Nonsteroidal antiinflammatory drugs
  • OnabotulinumtoxinA
  • Oral Contraceptives
  • Pamidronate
  • Paromomycin
  • Plazomicin
  • Polymyxin B
  • Procainamide
  • Procaine
  • Propofol
  • Pyridostigmine
  • Quinidine
  • RimabotulinumtoxinB
  • Salicylates
  • Sevoflurane
  • Streptomycin
  • Tacrine
  • Tacrolimus
  • Telavancin
  • Tenofovir Alafenamide
  • Tenofovir Alafenamide
  • Tenofovir, PMPA
  • Thiopental
  • Tobramycin
  • Valacyclovir
  • Vancomycin
  • Warfarin
  • Zoledronic Acid

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