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 aeruginosa, Acinetobacter 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
- Acinetobacter baumannii
- Acinetobacter sp.
- Citrobacter sp.
- cystic fibrosis
- Enterobacter sp.
- Escherichia coli
- gram-negative infection
- Haemophilus influenzae (beta-lactamase negative)
- Haemophilus influenzae (beta-lactamase positive)
- Klebsiella aerogenes
- Klebsiella pneumoniae
- meningitis
- Morganella morganii
- Mycobacterium fortuitum
- Mycobacterium intracellulare
- Mycobacterium phlei
- Mycobacterium smegmatis
- Mycobacterium tuberculosis
- Mycobacterium xenopi
- nosocomial pneumonia
- Pseudomonas aeruginosa
- Salmonella sp.
- Shigella sp.
- Stenotrophomonas maltophilia
- ventriculitis
- Yersinia pseudotuberculosis
- Yersinia sp.
Side Effects
- anaphylactoid reactions
- anuria
- apnea
- ataxia
- bronchospasm
- candidiasis
- confusion
- cough
- cylindruria
- diarrhea
- dizziness
- dysarthria
- fever
- hallucinations
- hearing loss
- hematuria
- myopathy
- oliguria
- paresthesias
- proteinuria
- pruritus
- pseudomembranous colitis
- psychosis
- rash
- renal failure (unspecified)
- renal tubular necrosis
- respiratory arrest
- seizures
- superinfection
- throat irritation
- urticaria
- vertigo
- 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
