Colistin (Polymyxin E, Colistimethate Sodium)


  • FDA Approval: in 1961



  • Polymyxin Antibiotic (see Polymyxins, [[Polymyxins]])


  • IV: 5 mg/kg/day or 150 mg q12 hrs
    • Recommended to achieve a blood level of at least 2 mcg/mL (this conflicts with package dosing instructions)
  • Inhalational:

Adverse Effects

Neurologic Adverse Effects

  • Neuromuscular Junction Antagonism with Respiratory Muscle Weakness (see Acute Hypoventilation, [[Acute Hypoventilation]] and Chronic Hypoventilation, [[Chronic Hypoventilation]])
    • Risk Factors for Neuromuscular Junction Antagonism
      • Intraperitoneal Adminsistration
      • Intrapleural Administartion
      • Chronic Kidney Disease (CKD)
      • Associated Use of Paralytics
    • Treatment: may respond to physostigmine

Renal Adverse Effects

  • Acute Kidney Injury (AKI) (see Acute Kidney Injury, [[Acute Kidney Injury]])
    • Mechanism: acute tubular necrosis (ATN)
    • AKI has been reported to occur in as many as 60% of cases [MEDLINE]
    • AKI is usually reversible (rarely progresses to end-stage renal disease) [MEDLINE]


  • Pharmacology of polymyxins: new insights into an ‘old’ class of antibiotics. Future Microbiol. 2013 Jun;8(6):711-24 [MEDLINE]
  • Higher Incidence of Acute Kidney Injury With Intravenous Colistimethate Sodium Compared With Polymyxin B in Critically Ill Patients at a Tertiary Care Medical Center. Clin Infect Dis. 2013 Nov;57(9):1300-1303 [MEDLINE]