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Colistin (polymyxin E) is a polymyxin antibiotic produced by certain strains of Paenibacillus polymyxa var.
colistinus. Colistin is a mixture of cyclic polypeptides
colistin A and B. Colistin is eective against most Gramnegative bacilli and is used as a polypeptide antibiotic. It
is commercially available as 'Xylistin' (India, marketed
by CIpla Pharmaceuticals ltd) and 'Koolistin' (India, registered and marketed by Biocon ltd)
2.2 Dosage
History
2.1
Forms
Colomycin 1,000,000
colistimethate;[11]
units
is
80
mg
Colistimethate sodium may be used to treat Pseudomonas aeruginosa infections in cystic brosis patients, and it has come into recent use for treating multidrug-resistant Acinetobacter infection, although resistant forms have been reported.[4][5]
Colistimethate sodium has also been given intrathecally and intraventricularly in Acinetobacter
baumanii and Pseudomonas aeruginosa meningitis/ventriculitis [6][7][8][9] Some studies have indicated that colistin may be useful for treating in1
5 RESISTANCE
Use of colistin to treat Acinetobacter baumannii infections has, as with other antibiotics, led to the development
of resistant bacterial strains. These resistant strains have
3 Mode of action
also been shown to develop resistance to antimicrobial
compounds, including LL-37 and lysozyme, produced as
Colistin is polycationic and has both hydrophilic and
part of the human hosts immune system.[25]
lipophilic moieties. These poly-cationic regions interact
with the bacterial outer membrane, by displacing bacterial counter ions in the lipopolysaccharide. Hydrophobic/hydrophilic regions interact with the cytoplasmic 5.1 Exceptional (inherently colistin resistant) Gram-negative bacteria
membrane just like a detergent, solubilizing the membrane in an aqueous environment. This eect is bacte Brucella
ricidal even in an isosmolaric environment.
Burkholderia cepacia
Chryseobacterium indologenes
Edwardsiella
Elizabethkingia meningoseptica
Francisella tularensis spp.
Gram-negative cocci
Helicobacter pylori
Moraxella catarrhalis
Morganella spp.
[19][20]
5.2
Aeromonas
Vibrio
Prevotella
Fusobacterium
Pharmacokinetics
Adverse reactions
References
[1] Falagas ME, Grammatikos AP, Michalopoulos A (October 2008). Potential of old-generation antibiotics
to address current need for new antibiotics. Expert review of anti-infective therapy 6 (5): 593600.
doi:10.1586/14787210.6.5.593. PMID 18847400.
[2] Kumarasamy KK, Toleman MA, Walsh TR, Bagaria J,
Butt F, Balakrishnan R et al. (2010). Emergence of a
new antibiotic resistance mechanism in India, Pakistan,
and the UK: a molecular, biological, and epidemiological
study. The Lancet Infectious Diseases 10 (9): 597602.
doi:10.1016/S1473-3099(10)70143-2. PMC 2933358.
PMID 20705517.
[12] http://www.emea.europa.eu/pdfs/vet/mrls/081502en.
pdf; NB. Colistin base has an assigned potency of 30 000
IU/mg
[13] Ahmed N, Wahlgren NG (2003). In vitro interaction of colistin and rifampin on multidrug-resistant Pseudomonas aeruginosa". J Chemother 15 (4): 23538.
doi:10.1159/000069498. PMID 12686786.
[14] Hogg GM, Barr JG, Webb CH (1998). In-vitro activity of the combination of colistin and rifampicin
against multidrug-resistant strains of Acinetobacter baumannii". J Antimicrob Chemother 41 (4): 49495.
doi:10.1093/jac/41.4.494.
[15] Petrosillo N, Chinello P, Proietti MF, Cecchini L, Masala
M, Franchi C et al. (2005). Combined colistin
REFERENCES
and rifampicin therapy for carbapenem-resistant Acinetobacter baumannii infections: clinical outcome and adverse events. Clin Microbiol Infect 11 (8): 682
83. doi:10.1111/j.1469-0691.2005.01198.x. PMID
16008625.
[31] Ledson MJ, Gallagher MJ, Cowperthwaite C, Convery RP, Walshaw MJ (1998).
Four years experience of intravenous colomycin in an adult cystic brosis unit. Eur Respir J 12 (3): 59294.
doi:10.1183/09031936.98.12030592. PMID 9762785.
[32] Li J, Nation RL, Milne RW, Turnidge JD, Coulthard K
(2005). Evaluation of colistin as an agent against multiresistant Gram-negative bacteria. Int J Antimicrob Agents
25 (1): 1125. doi:10.1016/j.ijantimicag.2004.10.001.
PMID 15620821.
[33] Beringer P (2001). The clinical use of colistin in patients with cystic brosis. Current Opinion in Pulmonary
Medicine 7 (6): 434440. doi:10.1097/00063198200111000-00013.
[34] Conway SP, Etherington C, Munday J, Goldman MH,
Strong JJ, Wootton M (2000). Safety and tolerability
of bolus intravenous colistin in acute respiratory exacerbation in adults with cystic brosis. Annals of Pharmacotherapy 34 (11): 123842. doi:10.1345/aph.19370.
PMID 11098334.
[35] Littlewood JM, Koch C, Lambert PA, Hiby N, Elborn JS, Conway SP et al. (2000). A ten year review of Colomycin. Respir Med 94 (7): 63240.
doi:10.1053/rmed.2000.0834. PMID 10926333.
[36] Stein A, Raoult D (2002). Colistin: an antimicrobial
for the 21st century?". Clin Infect Dis 35 (7): 9012.
doi:10.1086/342570. PMID 12228836.
[37] Maddison J, Dodd M, Webb AK (1994). Nebulized
colistin causes chest tightness in adults with cystic brosis. Respir Med. 88 (2): 145147. doi:10.1016/09546111(94)90028-0.
[38] Kamin W, Schwabe A, Krmer I (2006). Inhalation solutions: which one are allowed to be mixed?
Physico-chemical compatibility of drug solutions in
nebulizers.
J Cyst Fibros.
5 (4): 205213.
doi:10.1016/j.jcf.2006.03.007. PMID 16678502.
[39] Domnguez-Ortega J, Manteiga E, Abad-Schilling C, Juretzcke MA, Snchez-Rubio J, Kindelan C (2007). Induced tolerance to nebulized colistin after severe reaction
to the drug. J Investig Allergol Clin Immunol 17 (1): 59
61. PMID 17323867.
9.1
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