Usual Adult Dose for Gram Negative Infection

Parenteral: 2.5 to 5 mg/kg/day IM or IV in 2 to 4 divided doses, depending on severity of infection
Maximum dose: 5 mg/kg/day

Comments:

• The dosage is expressed in terms of colistin base.
• Clinical effectiveness has been shown in the treatment of infections due to Enterobacter aerogenes, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa.

Approved indication: Treatment of acute or chronic infections due to sensitive strains of certain gram-negative bacilli (particularly infections due to P aeruginosa); not indicated for infections due to Proteus or Neisseria

Some experts recommend:
Inhalation: 50 to 75 mg in normal saline (3 to 4 mL total volume) via nebulizer 2 to 3 times a day

Usual Pediatric Dose for Gram Negative Infection

Parenteral: 2.5 to 5 mg/kg/day IM or IV in 2 to 4 divided doses, depending on severity of infection
Maximum dose: 5 mg/kg/day

Comments:

• The dosage is expressed in terms of colistin base.
• Clinical effectiveness has been shown in the treatment of infections due to Enterobacter aerogenes, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa.

Approved indication: Treatment of acute or chronic infections due to sensitive strains of certain gram-negative bacilli (particularly infections due to P aeruginosa); not indicated for infections due to Proteus or Neisseria

Some experts recommend:
Inhalation:
Neonates: 4 mg/kg/dose every 12 hours to treat ventilator-associated pneumonia
Infants, children, adolescents: 50 to 75 mg in normal saline (3 to 4 mL total volume) via nebulizer 2 to 3 times a day

Renal Dose Adjustments

Colistimethate should be used with extreme caution in the presence of renal dysfunction.

Suggested modification for adults:
Normal renal function (CrCl 80 mL/min or greater): 2.5 to 5 mg/kg/day IM or IV in 2 to 4 divided doses
Mild renal dysfunction (CrCl 50 to 79 mL/min): 2.5 to 3.8 mg/kg/day IM or IV in 2 divided doses
Moderate renal dysfunction (CrCl 30 to 49 mL/min): 2.5 mg/kg/day IM or IV in 1 to 2 divided doses
Severe renal dysfunction (CrCl 10 to 29 mL/min): 1.5 mg/kg IM or IV every 36 hours

If signs of impaired renal function occur (including decreased urine output, rising serum creatinine and BUN, and decreased CrCl): Colistimethate should be discontinued at once.

Liver Dose Adjustments

No adjustment recommended.

Dose Adjustments

The dosage should be based on ideal body weight in obese patients.

Precautions

Consult WARNINGS section for dosing related precautions.

Dialysis

Data not available

Other Comments

Administration advice:

• Colistimethate is only approved by the FDA for IM or IV administration; it is not approved for use as a liquid to be inhaled via nebulizer. If the liquid form is used in a nebulizer, it should be used promptly after it is mixed. Any unused premixed liquid form of colistimethate should be discarded.

Storage requirements:

• Vials should be stored at controlled room temperature prior to reconstitution.
• Reconstituted solution should be stored in refrigerator 2 degrees to 8 degrees Celsius (36 degrees to 46 degrees Fahrenheit) or between 20 degrees to 25 degrees Celsius (68 degrees to 77 degrees Fahrenheit) and used within 7 days.
• Any final IV infusion solution containing colistimethate sodium should be freshly prepared and used for no longer than 24 hours.

Reconstitution/preparation techniques:

• The manufacturer's product information should be consulted.

General:

• The dosage is expressed in terms of colistin base.
• Supplied in vials containing colistimethate sodium equal to 150 mg colistin base activity per vial.

Monitoring:

• General: Close clinical monitoring of pediatric patients.
• Renal: Renal function, especially in elderly patients.

Patient advice:

• Patients should be advised to avoid driving or using hazardous machinery during therapy.