COLISTIN: adult and paediatric guideline for South Africa, 2016

Figures & data

Table 1 Recommended adult dosages of IV colistin (CMS) in critically-ill patients

Normal renal function:	Loading dose: 12 million units
	Then:
	3 million units every 8 hours
	Or:
	4.5 million units every 12 hours
Renal impairment:
• CrCl* 40-60 ml/min	2 million units every 12 hours
• CrCl* 10-40 ml/min	2 million units every 24 hours
• CrCl* <10 ml/min	1.5 million units every 36 hours
Renal replacement therapy:
• Haemodialysis	As per CrCl*, with an additional 2 million units after dialysis
• CVVHD**	Dosing as for normal renal function

^* Creatinine clearance (CrCL) based on Cockcroft-Gault equation;

^** Continuous veno-venous hemodialysis

Table 2 Colistin (CMS) dosages and dosing interval terminology

1 Vial = 1 MU = 80mg CMS = 30mg colistin base

Table 3 Recommended paediatric dosages for colistin (CMS)

	Dosage based on Colistimethate Sodium (CMS)
Neonates	50 000 - 75 000 IU/kg/day in three divided dosages^16,19^*
Infants and children	75 000 - 150 000 IU/kg/day in three divided dosages.^16,17
Inhalation CMS	< 40kg: 500 000 IU every 12 hours
	> 40kg: 1 000 000 IU (1MU) every 12 hours^16,20

^* Note that 75 000 – 120 000 IU/kg/day in three divided dosages have been used in this population¹⁵

Table 4 Colistin (CMS) reconstitution outline information

Dosage	Final volume	Diluent	Infusion time
12 MU loading dose	100 ml	0.9% sodium chloride (normal saline)	60 minutes
3 MU 8 hourly	50-100 ml	0.9% sodium chloride (normal saline)	15-30 minutes
4.5 MU 12 hourly	50-100 ml	0.9% sodium chloride (normal saline)	15-30 minutes

Table 5 The dosing of aerosolised colistin

Body weight	Dosing recommendation
<40 kg	500 000 IU 12-hourly
>40 kg	1 000 000 IU 12-hourly
Recurrent/severe pulmonary infections	2 000 000 IU 8-hourly

Table

Pseudomonas aeruginosa
Klebsiella pneumonia
Acinetobacter baumannii
Carbapenem-resistant enterobacteriaceae

Table

Dosing in normal patients
• Loading dose		12 MU
• Maintenance dose		3 MU tds (8-hourly)
		Or 4.5 mu bd (12-hourly)

Table

Renal impairment:
• CrCl* 40-60 ml/min		2 million units, 12-hourly
• CrCl* 10-40 ml/min		2 million units, 24-hourly
• CrCl* <10 ml/min		1.5 million units, 36-hourly
Renal replacement therapy:
• Haemodialysis		As per CrCl*, with an additional 2 million units after dialysis
• CVVHD**		Dosing as for normal renal function

Kumar P, Giri S, Shaikh F, et al. Safety and efficacy of intravenous colistin in children. Indian Pediatr. 2015;52(2):129–130.

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