Dose Conversion
- 1 mg colistin BASE activity (CBA) = 2.4 mg colistimethate sodium
- 1 mg colistin BASE activity (CBA) = 30,000 IU
- 1 mg colistimethate sodium (CMS) = 12,500 IU
- Best practices for colistin dosing are unclear
- Dosing of colistin in hemodialysis patients has varied in published reports
- manufacturer does not provide dosing recommendations for hemodialysis patients or for peritoneal dialysis patients
- intermittent hemodialysis removed a significant quantity of colistin and colistimethate
1. http://www.asp.mednet.ucla.edu/files/view/guidebook/Colistin_Dosing
- High-dose CBA (optimizes the concentration-dependent bactericidal activity).
- loading dose is included to ensure that therapeutic concentrations are rapidly achieved.
- In the absence of a loading dose, it may take 48 hours before colistin concentrations exceed the bacterial minimum inhibitory concentration
OR
2. http://www.nebraskamed.com/careers/education-programs/asp/restrictions/colistin- Maintenance dose and dosing interval should be based on the renal dosing protocol
- A load of 2.5 mg/kg IV q12h x2doses should be given to all patients with a creatinine clearance (CrCl) of <= 40 ml/min (the loading doses are not renally adjusted)
- Subsequent maintenances doses should begin 24 hours after the first loading dose
- In pediatric patients use 1.5 mg/kg/day divided q12h
CrCl 20-40: 75% of total daily dose IV divided q12h
CrCl 10-19: 50% of total daily dose IV divided q12h
CrCl <10, intermittent hemodialysis, or peritoneal dialysis: 50 mg IV q12h. Administered after dialysis on dialysis days
OR
3. http://www.infectiousdiseases-ucla-affiliated.org/Intranet/FILES/ColistinDosingLoading dose
- (LD, All patient categories) LD of CBA (mg) =5.0 x body wt (kg)
- Use the lower of ideal or actual body wt (kg)
- Not to exceed 300mg
Maintenance dose:
- 1 st dose should be given 24 hours after LD
- Not on renal replacement therapy: Daily dose of CBA (mg) = 2.5 x (1.5xCrcl+30)
- Dosing interval adjusted based on CrCl (ml/min/1.73m2):
- CrCl70ml/min/1.73m2 = q8h
- None HD day- Daily dose of CBA = 75mg; given as 37.5 mg q 12h
- On days when dialysis is given an additional 30% of the daily maintenance dose is given after HD [exm: 1 st dose = 37.5mg. Second dose (12 hours later) = 60 mg ]
- Daily dose =480mg; give as 160 mg q 8 h.
OR
4. Medscape- intravenous dosages of CMS are 2–3 mg/kg after each hemodialysis treatment
Suggestion:
- Based on available guides, do suggest to use a BD dosing to achieve therapeutic level
- (case report: patient received 2 million units of colistimethate every 12 hours, and received hemodialysis on a daily basis. Patient achieved close to the MIC breakpoint of 2 mg/L)
- As most recommendations are at a lower dosing, would suggest for initiation at 1-1.5 million Unit BD rather than 2 million unit.
References:
- http://www.ahcmedia.com/articles/20230-colistin-dosing-in-renally-impaired-patients
- http://www.asp.mednet.ucla.edu/files/view/guidebook/Colistin_Dosing
- http://www.nebraskamed.com/careers/education-programs/asp/restrictions/colistin
- http://www.infectiousdiseases-ucla-affiliated.org/Intranet/FILES/ColistinDosing
- https://www.medicines.org.uk/EMC/medicine/1590/SPC/Colomycin+Injection/
- http://www.medscape.com/viewarticle/772588_4
- http://ac.els-cdn.com/S120197121401666X/1-s2.0-S120197121401666X-main
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