Colistin: Difference between revisions

From IDWiki
No edit summary
()
Line 1: Line 1:
* A member of the polymyxin class also known as polymyxin E
+
*A member of the polymyxin class also known as polymyxin E
* Active against most gram-negatives except for [[Proteus species]] and several others (see ''Resistance'', below)
+
*Active against most gram-negatives except for [[Proteus species]] and several others (see ''Resistance'', below)
* Currently reserved for resistant [[Pseudomonas aeruginosa]], [[Acinetobacter baumannii]], and carbapenem-resistant Enterobacteriaceae
+
*Currently reserved for resistant [[Pseudomonas aeruginosa]], [[Acinetobacter baumannii]], and carbapenem-resistant Enterobacteriaceae
   
== Background ==
+
==Background==
=== Mechanism of Action ===
+
===Mechanism of Action===
* Disrupt membranes by interacting with membrane phospholipids to displace divalent cations
 
* Also bind lipid A in the cell wall lipopolysaccharide
 
   
 
*Disrupt membranes by interacting with membrane phospholipids to displace divalent cations
=== Resistance ===
 
 
*Also bind lipid A in the cell wall lipopolysaccharide
* Conferred by alterations in lipid A, either reducing its charge or eliminating it altogether
 
* May be chromosomal (e.g. pmrC, pmrF, pmrAB, lpxA, lpxC, lpxD, OprH) or plasmid-mediated (e.g. mcr-1 gene)
 
* Often seen in ''Proteus'', ''Providencia'', ''Serratia'', ''Morganella'', ''Burkholderia cepacia'', ''Neisseria'', and ''Burcella''
 
   
== Dosing ==
+
===Resistance===
* Dosing is a mess, with a number of different units used by different people, despite having a standardized international unit, usually in millions (MIU)
 
** 1 MIU = 80 mg colistimethate (CMS) in Europe
 
** 1 MIU = 30 mg colistin base activity (CBA) in the US
 
* For European dosing, using IU of CMS:
 
** Weight ≤60 kg: 50-75 kIU/kg/day divided q8h
 
** Weight >60 kg: 1-2 MIU q8h, dose-adjusted to q12-18h for CrCl 10-20 and q18-24h for CrCl <10
 
* For US dosing, using mg of CBA:
 
** 2.5-5 mg/kg ideal body weight daily divided q12h to q6h
 
** E.g. 300 mg CBA (10 IU) daily for a 60 kg patient, compared to 3 to 4.5 MIU daily in Europe
 
* Per Mandell:
 
** 5 mg CBA/kg IBW as loading dose (max 300 mg) followed by 5 mg CBA/kg IBW daily divided q8h
 
** Maintenance is renally adjusted to 3.5 mg/kg/day divided q12h for CrCl 30-49, 2.5 mg/kg/day divided q12h for CrCl 10-29, and 1.5 mg/kg q24h for CrCl <10 or hemodialysis
 
   
 
*Conferred by alterations in lipid A, either reducing its charge or eliminating it altogether
== Adverse Effects ==
 
 
*May be chromosomal (e.g. pmrC, pmrF, pmrAB, lpxA, lpxC, lpxD, OprH) or plasmid-mediated (e.g. mcr-1 gene)
* Prominent and common '''nephrotoxicity''', which is dose-related and usually reversible
 
 
*Often seen in ''[[Proteus species|Proteus]]'', ''[[Providencia species|Providencia]]'', ''[[Serratia species|Serratia]]'', ''[[Morganella species|Morganella]]'', ''[[Burkholderia species|Burkholderia]]'', ''[[Neisseria species|Neisseria]]'', and ''[[Brucella species|Brucella]]''
* Rarely, '''neuromuscular blockage''', which can cause weakness and apnea
 
   
  +
==Dosing==
  +
 
*Dosing is a mess, with a number of different units used by different people, despite having a standardized international unit, usually in millions (MIU)
 
**1 MIU = 80 mg colistimethate (CMS) in Europe
 
**1 MIU = 30 mg colistin base activity (CBA) in the US
 
*For European dosing, using IU of CMS:
 
**Weight ≤60 kg: 50-75 kIU/kg/day divided q8h
 
**Weight >60 kg: 1-2 MIU q8h, dose-adjusted to q12-18h for CrCl 10-20 and q18-24h for CrCl <10
 
*For US dosing, using mg of CBA:
 
**2.5-5 mg/kg ideal body weight daily divided q12h to q6h
 
**E.g. 300 mg CBA (10 IU) daily for a 60 kg patient, compared to 3 to 4.5 MIU daily in Europe
 
*Per Mandell:
 
**5 mg CBA/kg IBW as loading dose (max 300 mg) followed by 5 mg CBA/kg IBW daily divided q8h
 
**Maintenance is renally adjusted to 3.5 mg/kg/day divided q12h for CrCl 30-49, 2.5 mg/kg/day divided q12h for CrCl 10-29, and 1.5 mg/kg q24h for CrCl <10 or hemodialysis
  +
 
==Adverse Effects==
  +
 
*Prominent and common '''nephrotoxicity''', which is dose-related and usually reversible
 
*Rarely, '''neuromuscular blockage''', which can cause weakness and apnea
   
 
[[Category:Polymyxins]]
 
[[Category:Polymyxins]]

Revision as of 19:22, 10 August 2020

Background

Mechanism of Action

  • Disrupt membranes by interacting with membrane phospholipids to displace divalent cations
  • Also bind lipid A in the cell wall lipopolysaccharide

Resistance

Dosing

  • Dosing is a mess, with a number of different units used by different people, despite having a standardized international unit, usually in millions (MIU)
    • 1 MIU = 80 mg colistimethate (CMS) in Europe
    • 1 MIU = 30 mg colistin base activity (CBA) in the US
  • For European dosing, using IU of CMS:
    • Weight ≤60 kg: 50-75 kIU/kg/day divided q8h
    • Weight >60 kg: 1-2 MIU q8h, dose-adjusted to q12-18h for CrCl 10-20 and q18-24h for CrCl <10
  • For US dosing, using mg of CBA:
    • 2.5-5 mg/kg ideal body weight daily divided q12h to q6h
    • E.g. 300 mg CBA (10 IU) daily for a 60 kg patient, compared to 3 to 4.5 MIU daily in Europe
  • Per Mandell:
    • 5 mg CBA/kg IBW as loading dose (max 300 mg) followed by 5 mg CBA/kg IBW daily divided q8h
    • Maintenance is renally adjusted to 3.5 mg/kg/day divided q12h for CrCl 30-49, 2.5 mg/kg/day divided q12h for CrCl 10-29, and 1.5 mg/kg q24h for CrCl <10 or hemodialysis

Adverse Effects

  • Prominent and common nephrotoxicity, which is dose-related and usually reversible
  • Rarely, neuromuscular blockage, which can cause weakness and apnea