Colistin, also known as polymyxin E, is an antibiotic that has been used for over fifty years to treat serious bacterial infections, particularly those caused by Gram-negative bacteria that are resistant to other antibiotics.
It is known for its rapid bactericidal activity and is often considered a last-resort treatment for multidrug-resistant infections.
Colistin is available in various forms, including injections (colistimethate sodium) and topical applications (colistin sulfate). However, oral tablets are less common and are typically used for specific purposes, such as bowel sterilization before surgery.
What is Colistin?
Colistin is a cyclic polypeptide antibiotic produced by Bacillus colistinus. It comes in two main forms: colistimethate sodium, which is used for injection or inhalation, and colistin sulfate, which is used topically or orally.
Colistimethate sodium is a prodrug that is less toxic than colistin when administered parenterally. Colistin is particularly effective against Gram-negative bacteria, such as Pseudomonas aeruginosa, Klebsiella pneumoniae, and Acinetobacter, which are often resistant to other antibiotics.
What Are the Uses of Colistin?
Colistin is a potent, last-resort antibiotic used to treat severe infections caused by multidrug-resistant Gram-negative bacteria. It is especially vital in hospital settings, where conventional antibiotics often fail due to rising bacterial resistance.
Conditions Colistin Treats
Colistin is effective in managing the following serious bacterial infections:
Hospital-acquired pneumonia (HAP), including ventilator-associated pneumonia
Wound and skin infections, especially in surgical or trauma patients
Secondary Uses of Colistin
Beyond direct infection treatment, Colistin is also used for:
Bowel sterilization prior to abdominal surgery
Managing infections in critically ill patients in ICU settings
Cases where first-line antibiotics (like carbapenems or cephalosporins) are no longer effective due to resistance
Colistin Injection Uses:
Colistin injection is commonly used in hospitalized or ICU patients for life-threatening infections. It is administered via intravenous (IV) or intramuscular (IM) routes under strict medical supervision.
Common Indications for Colistin Injection:
Infections caused by resistant Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumannii, and Escherichia coli
UTIs that are unresponsive to standard antibiotics
Septicemia (bloodstream infection)
Pulmonary infections in cystic fibrosis patients
Note: Colistin injection is not effective against viral infections. It should be used only for confirmed or strongly suspected bacterial infections
How Does Colistin Work?
Colistin works by binding to the lipopolysaccharide (LPS) in the outer membrane of Gram-negative bacteria, disrupting the membrane and causing the leakage of bacterial contents, which leads to cell death.
This mechanism makes it particularly effective against Gram-negative bacteria. It does not affect Gram-positive bacteria or fungi.
Colistin Dosage
Colistin (colistimethate sodium) dosing depends on the formulation, route of administration, patient age, weight, renal function, and severity of infection.
Dosage is typically expressed in terms of colistin base activity (CBA) or international units (IU), and clarity about which is being used is essential to avoid dosing errors.
Adult Dosage (IV/IM)
Usual dose: 2.5-5 mg/kg/day (colistin base) divided into 2-4 doses (IV or IM), not to exceed 5 mg/kg/day.
Alternative (IU): 4-6 mg/kg/day (50, 000-75, 000 IU/kg/day) in three divided doses.
Fixed dosing: For adults >40 kg, 2 million units every 8 hours; for adults 2 years.
Loading dose: Many experts recommend a loading dose of 9 million IU (approx. 300 mg CBA), followed by maintenance doses of 4.5 million IU every 12 hours for severe infections.
Inhalation: 75-150 mg colistin base inhaled every 12 hours; for ventilator-associated pneumonia, up to 150 mg every 8 hours.
Pediatric Dosage
IV/IM: 2.5-5 mg/kg/day (colistin base) in 2-4 divided doses, not to exceed 5 mg/kg/day.
Loading dose: 4-5 mg/kg (colistin base) as a single dose, then maintenance of 2.5 mg/kg every 12 hours in children >2 years.
Inhalation: 30-75 mg colistin base inhaled every 12 hours for children <13 years; 50-75 mg via nebulizer 2-3 times daily for infants, children, and adolescents.
Neonates: 4 mg/kg/dose every 12 hours for ventilator-associated pneumonia (inhaled)
Renal Impairment Adjustments
Dose reduction is required in renal dysfunction, with specific recommendations based on creatinine clearance and dialysis schedules.
For example, during intermittent hemodialysis, 2 million IU every 12 hours on non-dialysis days, with extra doses post-dialysis.
Special Administration
Intraventricular/intrathecal: Used for CNS infections in conjunction with IV therapy; dosing varies by age and indication, e.g., 0.26 mg CBA/day (neonates), 1.7 mg CBA/day (infants), 2.6-4.25 mg CBA/day (children >1 year).
Key Points
Always verify whether dosing is expressed as colistin base or IU to avoid confusion.
Monitor renal function closely due to risk of nephrotoxicity, especially with higher or prolonged dosing.
Therapeutic drug monitoring is not widely available but may be beneficial where possible.
Do not exceed 5 mg/kg/day (colistin base) in adults or children unless specifically justified, as higher doses increase toxicity risk.
Consult local protocols and infectious disease specialists for complex cases or when using combination therapy.
What Should I Do If I Miss a Dose of Colistin?
If you miss a dose, take it as soon as you remember. If it is almost time for the next dose, skip the missed dose and continue with your regular schedule. Do not double the dose to catch up.
What Happens If I Overdose?
Symptoms of overdose may include stomach ache, nausea, vomiting, and in severe cases, respiratory arrest. If you suspect an overdose, seek medical attention immediately.
Colistin Dose
Susceptible infections: 2.5 mg/kg/day divided every 6-12 hours intravenously/intramuscularly
Renal Impairment: 2.5-3.8 mg/kg/day IV/IM divided every 12 hours
Get a second opinion from trusted experts and makeconfident, informed decisions.
Colistin can cause several side effects, ranging from common to serious. It is important to monitor for these effects and consult a doctor if they persist or worsen.
If any side effects persist or worsen, contact your doctor immediately.
Precautions and Warnings
Before using Colistin, inform your doctor if you are allergic to it or to related medications like polymyxin B. It should be used with caution in patients with kidney disease, liver disease, or nerve/muscle disorders.
Colistin may interact with other medications, so it is important to inform your doctor about all the medicines you are taking.
Who Should Avoid This Medicine
Patients with known hypersensitivity to Colistin or polymyxin B. Patients with severe kidney impairment (unless absolutely necessary and under close monitoring)
Are There Any Age Restrictions for Using Colistin?
For children under 12, the safety and efficacy of some forms are not established.
Alcohol or Food Interactions
Limit alcoholic beverages as they may increase dizziness.
No specific food interactions are noted, but follow your doctor's advice on diet.
Colistin Contraindications
Known hypersensitivity to Colistin or polymyxin B
Severe kidney impairment (unless necessary and monitored)
Possible Interactions with Other Medications
Colistin may interact with other drugs, particularly those that affect the kidneys or the nervous system. Always inform your doctor about all medications, supplements, and herbal products you are taking.
Colistin should be stored at room temperature between 68°F and 77°F (20°C and 25°C), away from heat, air, and light. Keep it out of reach of children and in a safe place to prevent accidental exposure.
What Happens If Colistin Is Not Stored Properly?
Improper storage may lead to degradation of the medication, reducing its effectiveness or potentially causing harm if used.
Colistin vs Meropenem
Colistin
Meropenem
Colistin is an antibiotic used to treat severe bacterial infections, especially when other antibiotics fail. It is particularly effective against infections caused by gram-negative bacteria.
Meropenem is a broad-spectrum antibiotic injection that works by killing bacteria. It is used for treating skin, abdominal infections, and bacterial meningitis.
It is also used for stomach and intestinal infections and to prevent bowel contamination before surgeries.
Meropenem is typically reserved for serious infections that require hospital treatment.
Colistin syrup is primarily used to treat bacterial infections of the gastrointestinal tract, especially those caused by Escherichia coli and other susceptible Gram-negative organisms. It is often prescribed for infectious diarrhea, enteritis, or intestinal inflammation in children and adults. The syrup form is convenient for patients who have difficulty swallowing tablets.
Colestin 140 tablet is used to manage intestinal infections caused by Gram-negative bacteria. It is typically prescribed for diarrhea, bacterial gastroenteritis, or enteric infections, especially when caused by drug-resistant strains. It acts locally in the gut and is often used under medical supervision to avoid resistance or misuse.
The gene has the ability to spread rapidly to other bacteria, increasing the risk that bacteria that are already immune to major antibiotics will also become resistant to colistin. Colistin is an important last-ditch choice. Because of its side effects, the medication is seldom used in routine treatment.
Colistin can be given as an aerosol or as an intramuscular or intravenous injection after reconstitution with 0.9 percent sodium chloride injection or sterile water for injection. When necessary, however, colistin may be administered in other ways, such as intrathecally.
Intravenous polymyxin B and colistin have recently become more widely used in the treatment of otherwise pan-resistant nosocomial infections, especially those caused by Pseudomonas and Acinetobacter spp. They're also used in aerosol form for cystic fibrosis patients.
Colistin injection is used to treat severe bacterial infections caused by multi-drug-resistant Gram-negative bacteria, including Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae. It is commonly used in hospitals for serious infections such as pneumonia, sepsis, meningitis, and urinary tract infections, especially when other antibiotics are ineffective.
Colistin Sulphate Oral Suspension IP is used in infants to treat bacterial infections of the gut, such as diarrhea or enteritis caused by sensitive Gram-negative bacteria. It is given orally and acts within the digestive tract, making it suitable for treating localized gut infections in babies. Dosage and duration should always be prescribed by a pediatrician to ensure safety and effectiveness.
Yes, Colistin is often used for hospital-acquired pneumonia caused by multidrug-resistant bacteria like Pseudomonas aeruginosa.
Yes, Colistin is sometimes used for UTIs caused by drug-resistant bacteria, especially when other antibiotics fail.
Disclaimer: The information provided is accurate and up-to-date to the best of our knowledge. However, it should not be considered a substitute for medical advice or consultation. We do not guarantee its completeness or accuracy. The absence of specific warnings does not mean a medicine is safe for all users. We are not responsible for any outcomes based on this information and strongly recommend consulting a doctor for any medical concerns or questions.
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