Colistin Between Nebulizer and Intravenous Forms in FADIC Blog

Colistin Between Nebulizer and Intravenous Forms

Colistin Between Nebulizer and Intravenous Forms

Colistin, or polymyxin E, is a bactericidal drug that disrupts the outer cell membrane of gram-negative rods. In addition to, primarily used for infections with Pseudomonas Aeruginosa and Acinetobacter baumannii.
It can beinhaled via nebulizerand has been used in certain settings, including adjunctive therapy to intravenous antibiotics for nosocomial pneumonia, Moreover, this is due to multidrug-resistant organisms.
It used in the management of patients with cystic fibrosis. However, the role of inhaled colistin in the management of gram-negative pneumonia is controversial.

Colistin

Recent Studies

This is controversial is due to some studies show no extra benefit and no difference in clinical outcomes. It shows no differences in mortality or intensive care unit length of stay and had an increased rate of bronchospasm.
In spite, a subsequent case-control study comparing inhaled to intravenous plus inhaled colistin showed greater clinical cure rates in the combined therapy group (69 versus 55 percent).
In addition to fewer days of mechanical ventilation given these conflicting reports and lack of prospective randomized trials. We do not routinely use inhaled colistin for gram-negative pneumonia.
However, it may be a useful adjunctive therapy in select multidrug-resistant cases. There is the concern that its use may select for resistance to it in organisms that are already widely resistant to other agents.
If used as a nebulized inhalation, you should mix it immediately prior to administration.

Colistin

The inhaled form depends on which product used. For example, Colistin Inhalation: 75mg in 3ml NS via nebulizer twice daily Delivery of aerosolized form not standardized.

Colistimethate is FDA approved only for injection into a vein or a muscle. Not FDA approved for use as a liquid to be inhaled via a nebulizer.
There is FDA Warning about using Colistin in Nebulizer Solution because of the possible connection between the use of a liquid solution of Colistimethate. If premixed for inhalation with a nebulizer and the death of a patient.
Because after mixing with sterile water and a buffer, Colistimethate undergoes spontaneous hydrolysis to the bioactive form colistin.
A component of colistin, polymyxin E1, is toxic to lung tissue. Premixing Ccolistimethate into an aqueous solution and storing it for longer than 24 hours. It results in increased concentrations of colistin in solution, increasing the potential for lung toxicity.

Important Suggestion from John Hopkin

Although inhaled Colistimethate used, often as last resort treatment method. There is a warning against delayed pharmacy compounding.
Since this may lead to the conversion of Colistimethate sodium to the biologically active colistin which in turn can lead to airway inflammation. In addition to reactive airways and ARDS if inhaled.
The authors from John Hopkin suggests that if the drug used by the inhalation route. Therefore, the reconstitution should be just prior to administration.

To Conclude:

Colistin not used routinely by inhalation. In addition to, used for gram-negative pneumonia. Although it may be a useful adjunctive therapy in select multidrug-resistant cases.
If used, done with caution and mixed IMMEDIATELY PRIOR to administration. As the drug breakdown products can cause direct damage to lung tissue, leading to potentially serious and life-threatening side effects.