Colistin: Uses, Dosage, and Antibiotic Resistance Explained

Summary of Key Points

Colistin is an antibiotic used to treat severe bacterial infections, particularly when other antibiotics are ineffective. It is commonly prescribed for conditions such as pneumonia, urinary tract infections, sepsis, and other infections caused by multidrug-resistant bacteria. Colistin is available in various forms, including injections and inhalation. Always consult your healthcare provider before starting or adjusting your dose. Our telemedicine providers are available to assist with your treatment plan.

Names of Medication

US Brand Name: Coly-Mycin M

Generic Name: Colistin (Polymyxin E)

The generic name refers to the active ingredient in the medication and is listed in parentheses next to the brand name.

Pharmacologic Category

Polymyxins

Other medications in this category include Polymyxin B.

Colistin Dosage Guidelines

Colistin is used to treat various serious bacterial infections. The dosage and duration of treatment depend on the specific infection being treated. Below are common indications and dosing guidelines for adults. Always consult your doctor before making any changes to your dose. If you need immediate advice, our telemedicine providers are available to assist.

1. Pneumonia: 2.5-5 mg/kg/day IV (intravenous) in 2 to 4 divided doses. Treatment typically lasts 7-14 days, depending on the severity of the infection.
2. Urinary Tract Infections (UTIs): 2.5-5 mg/kg/day IV in 2 to 4 divided doses. Treatment usually lasts 7-10 days.
3. Sepsis: 2.5-5 mg/kg/day IV in 2 to 4 divided doses. Treatment duration varies based on severity, generally lasting 7-14 days.
4. Meningitis: 5 mg/kg/day IV in 2 to 4 divided doses. Treatment typically lasts 10-14 days.
5. Intra-abdominal Infections: 2.5-5 mg/kg/day IV in 2 to 4 divided doses for 7-14 days.
6. Skin Infections: 2.5-5 mg/kg/day IV in 2 to 4 divided doses for 7-10 days.
7. Bone Infections: 2.5-5 mg/kg/day IV in 2 to 4 divided doses for 4-6 weeks, depending on the severity of the infection.
8. Bloodstream Infections: 2.5-5 mg/kg/day IV in 2 to 4 divided doses for 7-14 days.
9. Respiratory Tract Infections: 2.5-5 mg/kg/day IV in 2 to 4 divided doses for 7-14 days.
10. Gastrointestinal Infections: 2.5-5 mg/kg/day IV in 2 to 4 divided doses for 7-14 days.

Dosage Forms and Strengths

Injection: 150 mg (as colistimethate sodium) per vial

Inhalation (nebulizer solution): 150 mg per vial

Administration Instructions for Colistin

Colistin is typically administered by a healthcare provider in a hospital or clinic setting, either as an intravenous (IV) infusion or as an inhalation solution for lung infections. If you are using Colistin at home, follow your healthcare provider’s instructions carefully. Be sure to complete the full course of treatment, even if you start feeling better. Stopping the medication too early may cause the infection to return or lead to antibiotic resistance.

Colistin Side Effects and Adverse Reactions

Like all medications, Colistin can cause side effects. Some are more common, while others are rare but potentially serious. If you experience any side effects, contact your healthcare provider immediately. You can also consult one of our telemedicine providers for guidance.

Common Side Effects

1. Nausea and Vomiting: Feeling sick or experiencing vomiting.
2. Dizziness: Feeling lightheaded or unsteady.
3. Rash: Skin irritation or redness.

Serious Side Effects (Less Common)

1. Kidney Damage (Nephrotoxicity): Colistin can affect kidney function, especially at higher doses or with prolonged use. Symptoms may include reduced urine output or swelling in the legs.
2. Nerve Damage (Neurotoxicity): Colistin may cause nerve damage, leading to symptoms such as numbness, tingling, or muscle weakness.
3. Breathing Problems: Inhaled Colistin may cause shortness of breath or wheezing.

Contraindications for Colistin

Contraindications are specific situations where a medication should not be used because it may be harmful. Colistin has certain conditions where its use is unsafe. Below is a list of contraindications and explanations for why Colistin should be avoided in these cases.

1. Allergy to Colistin or Polymyxins: If you have a known allergy to Colistin or other polymyxin antibiotics, taking this medication could trigger a severe allergic reaction, including life-threatening anaphylaxis.
2. Myasthenia Gravis: Colistin can worsen muscle weakness in individuals with myasthenia gravis, a condition that affects muscles and nerves. This could lead to breathing difficulties and other serious complications.
3. Kidney Disease: Colistin is processed by the kidneys. If you have severe kidney disease, the drug may accumulate in your body, leading to toxic effects. Dosage adjustments may be required, but in severe cases, it may be contraindicated.

Drug-to-Drug Interactions with Colistin

Colistin can interact with other medications, increasing the risk of side effects or reducing its effectiveness. It is important to inform your healthcare provider about all medications you are taking, including over-the-counter drugs and supplements. Below is a list of medications that may interact with Colistin:

1. Aminoglycosides (e.g., Gentamicin, Tobramycin): These antibiotics can increase the risk of kidney damage when taken with Colistin.
2. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) (e.g., Ibuprofen, Naproxen): These drugs can also heighten the risk of kidney damage when used with Colistin.
3. Neuromuscular Blocking Agents (e.g., Succinylcholine, Vecuronium): These drugs can enhance Colistin’s muscle-weakening effects, potentially leading to breathing difficulties.
4. Loop Diuretics (e.g., Furosemide, Bumetanide): These medications can increase the risk of kidney damage and hearing loss when taken with Colistin.

Colistin in Pregnancy

Is it safe to take Colistin when pregnant?

There is limited information available regarding the safety of Colistin during pregnancy. While animal studies suggest potential risks, there is not enough evidence to confirm these risks in humans. Colistin should only be used during pregnancy if the potential benefits outweigh the risks. If you are pregnant or planning to become pregnant, it’s essential to discuss this with your healthcare provider. They will help you carefully weigh the risks and benefits of using Colistin during pregnancy. You can also consult one of our providers via telemedicine to explore your options further.

Colistin while Breastfeeding

Is it safe to take Colistin while breastfeeding?

There is insufficient data to determine whether Colistin passes into breast milk or its potential effects on a nursing infant. Due to the risk of serious side effects, including kidney and nerve damage, it is generally recommended to avoid using Colistin while breastfeeding unless absolutely necessary. If you are breastfeeding and require treatment with Colistin, consult your healthcare provider to discuss safer alternatives or whether you should temporarily stop breastfeeding while taking the medication. Our telemedicine providers are available to help you make the best decision for both your health and your baby’s well-being.

Estimated Cost of Colistin Medication

The estimated cost of a 30-day supply of Colistin without insurance, using a GoodRX coupon, typically ranges from $150 to $300. Prices may vary depending on the pharmacy and your location. It’s always a good idea to check for discounts or coupons to help lower the cost of your prescription.

Possible Alternatives to Colistin

If Colistin is not the right option for you, there are alternative treatments available for the conditions it commonly treats. Below are some possible alternatives for different infections. Always discuss these options with your healthcare provider before making any changes to your treatment plan. Our telemedicine providers can help you explore these alternatives in more detail.

1. Pneumonia: Alternatives may include antibiotics such as Levofloxacin, Azithromycin, or Ceftriaxone, depending on the type of bacteria causing the infection. Lifestyle changes, such as quitting smoking and improving air quality at home, can also help prevent pneumonia.
2. Urinary Tract Infections (UTIs): Common alternatives include Nitrofurantoin, Trimethoprim-Sulfamethoxazole (Bactrim), or Fosfomycin. Staying hydrated and urinating frequently can help prevent UTIs.
3. Sepsis: Treatment alternatives depend on the source of infection, but broad-spectrum antibiotics like Piperacillin-Tazobactam or Meropenem are often used. Early detection and treatment are critical for managing sepsis.
4. Meningitis: Ceftriaxone or Vancomycin are commonly used alternatives for bacterial meningitis. Vaccination can help prevent certain types of meningitis.
5. Intra-abdominal Infections: Alternatives may include Metronidazole combined with Ciprofloxacin or Piperacillin-Tazobactam. Maintaining good hygiene and proper food handling can help reduce the risk of these infections.
6. Skin Infections: Alternatives include Clindamycin, Doxycycline, or Trimethoprim-Sulfamethoxazole (Bactrim). Keeping wounds clean and dry can help prevent skin infections.
7. Bone Infections (Osteomyelitis): Treatment alternatives may include Vancomycin or Linezolid. In some cases, surgical intervention may also be necessary.
8. Bloodstream Infections: Alternatives include broad-spectrum antibiotics like Cefepime or Meropenem. Early treatment is crucial for managing bloodstream infections.
9. Respiratory Tract Infections: Alternatives include Amoxicillin-Clavulanate or Azithromycin. Avoiding smoking and reducing exposure to pollutants can help prevent respiratory infections.
10. Gastrointestinal Infections: Alternatives may include Metronidazole or Ciprofloxacin, depending on the cause of the infection. Practicing good hygiene and safe food handling can help prevent these infections.

Recent Updates on Colistin Research

Recent studies have highlighted the growing resistance of bacteria to Colistin, particularly in hospital settings. Researchers are investigating ways to combat this antibiotic resistance, including combining Colistin with other antibiotics to improve its effectiveness. Additionally, new formulations of Colistin are being developed to reduce its toxic effects on the kidneys and nervous system. Ongoing research aims to better understand how Colistin can be used safely and effectively in treating multidrug-resistant infections. If you have concerns about antibiotic resistance or the safety of Colistin, our telemedicine providers can offer guidance and discuss the latest research with you.

James Kingsley

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