Colistimethate
Also known as: CMS, Colistimethate sodium, Colistin, Colistin methanesulfonate, Colistin methanesulfonate sodium, Coly-Myc, Coly-Mycin M, Polymyxin E methanesulfonate
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Summary
Colistimethate sodium (colistin methanesulfonate) is a prodrug of colistin, a polymyxin E antibiotic used intravenously or by inhalation to treat infections caused by multidrug‑resistant Gram‑negative bacteria.
Mechanism of Action
Binds to lipopolysaccharide of Gram-negative bacterial outer membrane, displaces calcium and magnesium ions, increases membrane permeability and causes cell death.
Routes of Administration
Goals & Uses
- Combination therapy for XDR infectionsAntimicrobialModerate
- Manage chronic Pseudomonas lung infection in cystic fibrosisAntibacterialHigh
- Treatment of MDR Gram-negative infectionsAntimicrobialHigh
- Ventilator-associated pneumonia (VAP) treatmentAntimicrobialModerate
- Pulmonary infection suppression in cystic fibrosisAntimicrobialModerate
- Treat multidrug‑resistant Gram‑negative infectionsAntibacterialHigh
Contraindications
- Severe pre-existing renal impairment (if alternatives exist)RenalHigh
- Hypersensitivity to colistin or polymyxinsAllergyHigh
- Severe renal impairment (creatinine clearance <30 mL/min) without dose adjustmentRenalModerate
- Hypersensitivity to colistin or other polymyxinsAllergyHigh
- Myasthenia gravisNeuromuscular DiseaseHigh
Adverse Effects
- NeurotoxicityNeurologicalCommon
- Injection site reactionsLocalCommon
- OtotoxicityAuditory/vestibularUncommon
- Electrolyte disturbancesMetabolicUncommon
- BronchospasmRespiratoryUncommon
- Neuromuscular blockadeNeuromuscularRare
- NephrotoxicityRenalCommon
- Superinfection / Clostridium difficileInfectiousUncommon
Drug Interactions
- Non‑steroidal anti‑inflammatory drugs (NSAIDs)Moderate
- AminoglycosidesModerate
- Neuromuscular blocking agents (e.g., vecuronium)High
- Non-depolarizing neuromuscular blocking agents (e.g., vecuronium)High
- Aminoglycosides (e.g., gentamicin, tobramycin)High
- VancomycinModerate
- NSAIDsModerateMay increase renal risk in susceptible patients
- Loop diuretics (e.g., furosemide)Moderate
Population Constraints
- PregnancyReproductive SafetyRelative
- Renal impairmentOrgan ImpairmentRelative
- Pediatrics (<1 month)AgeRelative
- Patients with neuromuscular disordersNeurologicalAbsolute
- Pediatric patientsAgeRelative
- Elderly patientsAgeRelative
- Pregnancy (Category C/D)PregnancyRelative
Regulatory Status
- European UnionApprovedApproved: Infections due to susceptible MDR Gram‑negative bacteriaEMA approval with similar restrictions.
- United StatesApprovedApproved: Complicated urinary tract infections, Ventilator‑associated pneumonia, Bloodstream infections caused by MDR Gram‑negative bacteriaColistimethate sodium approved under FDA for limited indications; restricted use program.
- United KingdomApprovedApproved: Serious infections due to susceptible Gram-negative organisms, Suppressive therapy of chronic pulmonary Pseudomonas aeruginosa infection in cystic fibrosisMHRA approved; available as Colomycin injection and Colobreathe inhalation powder; NICE guidelines support use in CF
Limited to severe infections due to high nephro‑ and neurotoxicity; dosing requires renal function monitoring; contraindicated in patients with known hypersensitivity to polymyxins.
Evidence & Sources
No sources recorded yet.
Frequently Asked Questions
What is Colistimethate?
Colistimethate sodium (colistin methanesulfonate) is a prodrug of colistin, a polymyxin E antibiotic used intravenously or by inhalation to treat infections caused by multidrug‑resistant Gram‑negative bacteria.
What is Colistimethate used for?
Colistimethate is educationally associated with: Combination therapy for XDR infections, Manage chronic Pseudomonas lung infection in cystic fibrosis, Treatment of MDR Gram-negative infections, Ventilator-associated pneumonia (VAP) treatment, Pulmonary infection suppression in cystic fibrosis, Treat multidrug‑resistant Gram‑negative infections. Educational only — not medical advice.
How is Colistimethate administered?
Recorded routes of administration: Inhalation, Intramuscular, Intrathecal, Intravenous.
What are the potential side effects of Colistimethate?
Reported adverse effects include: Neurotoxicity, Injection site reactions, Ototoxicity, Electrolyte disturbances, Bronchospasm, Neuromuscular blockade, Nephrotoxicity, Superinfection / Clostridium difficile. This list is not exhaustive — consult a qualified clinician.
Who should avoid Colistimethate?
Recorded contraindications: Severe pre-existing renal impairment (if alternatives exist), Hypersensitivity to colistin or polymyxins, Severe renal impairment (creatinine clearance <30 mL/min) without dose adjustment, Hypersensitivity to colistin or other polymyxins, Myasthenia gravis. Consult a qualified clinician before use.