Colistin
Also known as: CMS, Colistimethate sodium, Colistin sulfate, Colomycin, Coly-Mycin, Coly-Mycin M, Polymyxin E
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Summary
Colistin (polymyxin E) is a polymyxin class antibiotic used for serious infections caused by multidrug‑resistant Gram‑negative bacteria, administered primarily intravenously or by inhalation.
Mechanism of Action
Binds to lipopolysaccharide and phospholipids of Gram‑negative bacterial outer membranes, disrupting membrane integrity and causing rapid cell death.
Routes of Administration
Goals & Uses
- Intestinal decontaminationAntimicrobialLow
- Treatment of carbapenem-resistant Klebsiella pneumoniae infectionsAntimicrobialModerate
- Inhalation therapy for pulmonary infections in cystic fibrosisAntimicrobialModerate
- Treatment of carbapenem-resistant Acinetobacter baumannii infectionsAntimicrobialModerate
- Treat multidrug‑resistant Gram‑negative infectionsAntibacterialHigh
- Treatment of multidrug-resistant Pseudomonas aeruginosa infectionsAntimicrobialModerate
Contraindications
- Severe renal impairment (eGFR <30 mL/min/1.73 m²)RenalModerate
- Hypersensitivity to colistin or polymyxinsAllergyHigh
- Severe pre-existing renal impairment (without dose adjustment)RenalHigh
- Known hypersensitivity to colistin or polymyxinsAllergyHigh
- Myasthenia gravisNeuromuscular DiseaseHigh
Adverse Effects
- NeurotoxicityNeurologicalUncommon
- Injection site reactionsLocalCommon
- OtotoxicityAuditory/vestibularRare
- Electrolyte disturbancesMetabolicUncommon
- BronchospasmRespiratoryUncommon
- Apnea / respiratory failureRespiratoryRare
- NephrotoxicityRenalCommon
Drug Interactions
- AminoglycosidesHigh
- Neuromuscular blocking agents (e.g., vecuronium)Moderate
- Non-depolarizing neuromuscular blocking agentsHigh
- VancomycinModerate
- NSAIDsModerateMay increase renal risk in susceptible patients
- Loop diuretics (e.g., furosemide)Moderate
Population Constraints
- PregnancyReproductive SafetyRelative
- Renal impairmentOrgan ImpairmentRelative
- Pediatric patients (<18 y)AgeRelative
- Elderly patientsAgeRelative
- Neonates and premature infantsPediatricRelative
- Pregnant womenReproductiveRelative
Regulatory Status
- European UnionApprovedApproved: Severe infections due to multidrug‑resistant Gram‑negative bacteriaApproved for IV use; inhaled colistin authorized in some member states for cystic fibrosis.
- United StatesApprovedApproved: Complicated urinary tract infections, Ventilator‑associated pneumonia, Bloodstream infections caused by susceptible Gram‑negative organismsIV formulation approved; inhalation use is off‑label.
- United KingdomApprovedApproved: Serious infections due to susceptible Gram-negative organisms, Chronic pulmonary infections in cystic fibrosis (inhaled)MHRA-approved. Listed as a reserve antibiotic; use guided by antimicrobial stewardship programs.
Limited to severe infections due to significant nephro‑ and neuro‑toxicity; dosing requires renal function monitoring.
Evidence & Sources
No sources recorded yet.
Frequently Asked Questions
What is Colistin?
Colistin (polymyxin E) is a polymyxin class antibiotic used for serious infections caused by multidrug‑resistant Gram‑negative bacteria, administered primarily intravenously or by inhalation.
What is Colistin used for?
Colistin is educationally associated with: Intestinal decontamination, Treatment of carbapenem-resistant Klebsiella pneumoniae infections, Inhalation therapy for pulmonary infections in cystic fibrosis, Treatment of carbapenem-resistant Acinetobacter baumannii infections, Treat multidrug‑resistant Gram‑negative infections, Treatment of multidrug-resistant Pseudomonas aeruginosa infections. Educational only — not medical advice.
How is Colistin administered?
Recorded routes of administration: Inhalation, Intramuscular, Intravenous, Oral, Topical.
What are the potential side effects of Colistin?
Reported adverse effects include: Neurotoxicity, Injection site reactions, Ototoxicity, Electrolyte disturbances, Bronchospasm, Apnea / respiratory failure, Nephrotoxicity. This list is not exhaustive — consult a qualified clinician.
Who should avoid Colistin?
Recorded contraindications: Severe renal impairment (eGFR <30 mL/min/1.73 m²), Hypersensitivity to colistin or polymyxins, Severe pre-existing renal impairment (without dose adjustment), Known hypersensitivity to colistin or polymyxins, Myasthenia gravis. Consult a qualified clinician before use.