Parenteral Manual

Colistimethate sodium

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
COLY-MYCIN, COLISTIN
Classification: 
Polymixin Antibiotic
Original Date: 
April 2013
Revised Date: 
June 2015
Indications: 
  • Treatment of infections due to gram negative organisms
  • Reserved for life threatening infections caused by organisms resistant to other less toxic antibiotics
Reconstitution and Stability: 
VIAL SIZE STERILE WATER for  INJECTION  REQUIRED FINAL CONCENTRATION
  150 mg                               2 mL 75 mg/mL (swirl gently to avoid frothing)
  • Reconstituted solution stable 7 days at room temperature or refrigerated
  • Diluted solution stable 24 hours
  • Color may vary from clear to beige or light yellow
Compatibility: 

- Solutions Compatible:  D5W, 0.9% NaCl, dextrose-saline combinations, ringer's lactate

- Additives/Above Cassette Compatible:  ampicillin

- Y-site Compatible:  no information

- Incompatible: cefazolin, hydrocortisone sodium succinate, erythromycin

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM YES
IV Direct YES
Infusion time: 3 - 5 minutes
IV Intermittent
Infusion		 YES
Dilution:  further dilute with compatible solutions
Infusion time:  30 minutes
IV Continuous
Infusion

YES
Infusion rate:  5 - 6 mg/hour
Give half the daily dose IV push, then 1 - 2 hours later give the other half by IV infusion over 22 - 23 hours
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Adult/Pediatric:

  • 2.5 - 5 mg/kg/day IM/IV divided Q6 - 12 hours
    Maximum:  5 mg/kg/day
  • Cystic Fibrosis:  5 - 8 mg/kg/day divided Q8 hours
    Maximum:  100 mg /dose  -higher doses have been used for multidrug resistant infection;  close monitoring is required

DOSING ADJUSTMENT IN RENAL IMPAIRMENT:

  • Serum Creatinine (mcmol/L)  115 - 133   - 2.5 - 3.8 mg/kg/day in 2 divided doses
                                            134 - 221   - 2.5 mg/kg/day  in 1 - 2 divided doses
                                            222 - 354   - 1.5 mg/kg every 36 hours
                                          

 

 

Potential hazards of parenteral administration: 
  • Nephrotoxicity - reversible if drug is discontinued
  • Neurotoxicity - peripheral paresthesia, tingling of the extremities or tongue, dizziness, vertigo , blurred vision, slurred speech, ataxia, confusion, coma, psychosis, seizures, neuromuscular blockade  - dose reduction may alleviate symptoms
  • Hypersensitivity reactions:  urticaria, rash
  • Colitis

 

Notes: 
  • Avoid use with other nephrotoxic and neurotoxic drugs

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