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Marquette General Health System
Pharmacy and Therapeutics Committee
Medication Guideline
Drug Classification: 8:12.28.28 Polymixins
Agent:
Colistimethate sodium (Coly-Mycin® M)
Formulary
X
Nonformulary
Restricted
X
Nonstock
Pharmacy and Therapeutics Committee-approved Indications for Inpatient Use: Colistimethate
sodium is approved for the treatment of infections caused by multi-drug resistant gram-negative pathogens
(i.e., Acinetobacter and Pseudomonas spp.). Use is restricted to the Infectious Disease Service.
Dosage & Administration: Colistimethate sodium (Coly-Mycin® M Parenteral) is supplied in the US in
vials containing colistimethate sodium equivalent to 150 mg colistin base activity per vial. The following
dosing information is expressed in terms of the colistin base.
Adults and pediatric patients: Colistin base should be given in 2 to 4 divided doses at dose levels of 2.5
to 5 mg/kg per day for patients with normal renal function, depending on the severity of the infection.
The recommended maximum daily dose of colistin base is 800 mg.
Obese Patients: Base dosage on ideal body weight
Renally impaired patients: See table below
Colistimethate sodium dosage adjustment in renal function
Renal Function
Normal
Mild
Moderate
Considerable
Plasma creatinine,
0.7-1.2
1.3-1.5
1.6-2.5
2.6-4
mg/100 mL
Urea clearance, %
80-100
40-70
25-40
10-25
of normal
Unit dose of colistin
base, mg
Frequency,
times/day
Total daily dose,
mg
Approximate daily
dose, mg/kg/day
100-150
75-115
66-150
100-150
4 to 2
2
2 or 1
Every 36 hrs
300
150-230
133-150
100
5
2.5-3.8
2.5
1.5
Note: the suggested unit dose is 2.5-5 mg/kg; however, the time interval between injections
should be increased in the presence of impaired renal function.
Dialysis: Recommendations vary. Consult Lexi-Comp drug information available in Up-To-Date.
Each 150 mg vial should be reconstituted with 2 mL Sterile Water for Injection, USP. The reconstituted
solution provides colistimethate sodium at a concentration equivalent to 75 mg/mL colistin base activity.
Doses may be given via direct intermittent administration (injected slowly over a period of 3 to 5 minutes) or
diluted infusions (50-100 mL of 0.9% sodium chloride) given over 15 to 30 minutes.
Document created: 07/13.
Revised: None.
Cross Reference: None.
Marquette General Health System
Marquette General Hospital
Marquette, MI 49855
This is a confidential professional/peer review and quality assessment document of Marquette General Health System of Marquette, MI. It is
protected from disclosure pursuant to the provisions of MCL 333.20175, MCL 333.21513, MCL 21515, MCL 331.531, MCL 331.533, MCL
330.1143a, and other state and federal laws. Unauthorized disclosure or duplication is absolutely prohibited.
Marquette General Health System
Pharmacy and Therapeutics Committee
Medication Guideline
Monitoring / Outcomes:
Therapeutic Response:
Improvement or resolution in clinical signs or symptoms of infection
Adverse Effects:
The most common treatment-emergent adverse effects reported with colistimethate sodium include
tingling of extremities and tongue, parathesia, rash, nephrotoxicity (increased blood urea nitrogen,
elevated creatinine and decreased creatinine clearance) and decreased urine output, and
respiratory distress.
Special Handling Procedures:
Colistimethate Sodium is not considered a hazardous drug.
Colistimethate Sodium is not considered a high-alert drug.
References:
1. AHFS Drug Information. Available at STAT!Ref Web site. http://online.statref.com. Accessed June 10,
2013.
2. UpToDate Web site. http://www.uptodate.com/contents/search. Accessed June 10, 2013.
3. Package insert: Colistimethate for injection (Coly-Mycin® M Parenteral). JHP Pharmaceuticals, LLC;
Rochester, MI 48307. Revised February 2011.
4. Lim LM, Ly N, Anderson D, Yang JC, et al. Resurgence of colistin: a review of resistance, toxicity,
pharmacodynamics, and dosing. Pharmacotherapy. 2010 Dec;30(12):1279-91.
5. Li J, Nation RL, Turnidge JD, et al. Colistin: the re-emerging antibiotic for multidrug-resistant Gramnegative bacterial infections. Lancet Infect Dis. 2006 Sep;6(9):589-601.
Document created: 07/13.
Revised: None.
Cross Reference: None.
Marquette General Health System
Marquette General Hospital
Marquette, MI 49855
This is a confidential professional/peer review and quality assessment document of Marquette General Health System of Marquette, MI. It is
protected from disclosure pursuant to the provisions of MCL 333.20175, MCL 333.21513, MCL 21515, MCL 331.531, MCL 331.533, MCL
330.1143a, and other state and federal laws. Unauthorized disclosure or duplication is absolutely prohibited.