Clinical beta
FMBM is currently in clinical beta. Content is for professional review/testing and must not replace local protocols, senior clinical judgment, or official prescribing references.
Drug Monograph
Colistin (polymyxin E)
Polymyxin (IV, inhaled)
Indication
CRE bacteremia/VAP combinations β’ MDR Pseudomonas inhaled CF/HAP
INDICATIONS (CORE USE)
**Last-line** MDR gram-negative (CRE, carbapenem-resistant Pseudomonas) β **nephrotoxicity**; **dosing units chaos** (colistin base vs CMS) β **pharmacy mandatory**.
ADULT DOSE (STANDARD)
IV: million IU / mg CMS β **never guess** β pharmacy nomogram
MAX DOSE
Toxicity-driven β renal adjustment non-negotiable
Route
IV, inhaled
PEDIATRIC DOSE
Specialist + pharmacy
Must-not-miss safety points
Major warning
- **Nephrotoxicity** near-universal vigilance - **Neurotoxicity** apnea with NMB/sedation stacks - **Dosing errors** between products/units β fatal - Inhaled vs IV indications different
USE IF: MDR gram-negative infection with documented susceptibility as part of combination + ID. AVOID IF: Susceptible carbapenem available; monotherapy bacteremia empiric.
Primary
Secondary
Other
STANDARD (ADULT PO)
IV dose in **million IU / mg CMS** β pharmacy nomogram only (never guess units)
ADULT DOSE
IV loading/maintenance per CMS IU nomogram β institution table only
PEDIATRIC DOSE
Per pediatric MDR protocol.
MAX DOSE
Renal adjustment lowers exposure β toxicity still occurs
Practical Note
Never co-administer curare-like neuromuscular blockade without ventilator control.
Clinical warnings
Adverse effects
Pediatrics
Specialist + pharmacy
Pregnancy
Human data poor β use only if no alternative
Lactation
unknown.
Renal impairment
**Mandatory** dose reduction; HD adjustment. **CrCl scaffold (FMBM β titrate to FDA/SFDA label + institutional pharmacy nomogram):** - **CrCl β₯50** β pharmacy CMS / institutional nomogram (often reduced vs conventional) - **CrCl 10β50** β aggressive **β dose / extend interval** β pharmacy - **CrCl <10** / **HD** β **mandatory** pharmacy dosing; **HD** session redosing per protocol
Hepatic impairment
No major guidance.
Elderly
AKI common baseline.
IV slow; inhaled with bronchodilator pretreatment.
Clinical Picture
**Life-threatening (first):** **AKI** / **apnea** (NMB stack); **severe neurotoxicity**. **Secondary:** paresthesias.
Immediate Actions
Stop β BMP; ventilatory support if weak/apneic; avoid NMB co-use unless controlled ICU
Antidote
No specific antidote; treat complications (e.g. anaphylaxis β epinephrine per ACLS)
Decontamination
N/A
Escalation
Dialysis-requiring AKI, respiratory failure β **ICU** + nephrology; **hemodialysis** may clear colistin β redose per protocol
Common mistakes, resistance logic, and bedside traps
**Hail Mary** for **CRE/MDR GNR**. **Pharmacy owns the math** β units kill people. **Kidneys** pay the bill.
Infection control + stewardship bundle mandatory. Newer agents (ceftazidime-avibactam etc.) may supersede when susceptible. Document two active agents when possible. *Stewardship (all antimicrobials):* Empiric choice β syndrome severity + **local antibiogram**; shortest effective course.
Renal elimination; poor lung penetration IV β inhaled for airway
Cationic detergent β disrupts outer membrane of gram-negatives.
Global data (no country-specific data available)
Saudi Arabia
(placeholder β verify local formulary)
Common trade names are curated examples only β formulations and availability vary. Verify the exact product name with your local pharmacy and national regulator before prescribing or dispensing.
Saudi Arabia
International