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Colistin Dosing Guidance – Adults
Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences
- To date, the dosing guidances available in South Africa included those by Visser Kift[1] and Labuschagne.[2] While very useful, these guidances were not developed using rigorous guideline development principles, and are subsequently described as narrative guidelines
- Patients were probably underdosed with colistin using these narrative guidelines, especially in renal impairment
- A new international guideline was developed in 2019 using accredited guideline development tools.[3] Dosing recommendations for colistin were developed by assessing empiric minimum inhibitory concentrations (MIC), drug exposure needed to overcome these MICs, the average steady-state drug concentration that correlates with overall drug exposure, and dose adjustments in renal impairment
Updated dosing of colistin for Tygerberg Hospital is based on an adapted version:
- Loading dose
- 9 million IU over 1 hour
- Maintenance dose
- Depends on renal function (see table below)
- Expressed as dose per infusion, 12-hourly, over 1 hour
- Normal renal function (creatinine clearance ≥80 mL/min)
- 5 million IU - Adjust according to creatinine clearance:
| Creatinine clearance | Dose in international units (IU) |
| ≥80 mL/min | 5.0 million IU |
| 60-80 mL/min | 4.5 million IU |
| 40-60 mL/min | 3.5 million IU |
| 20-40 mL/min | 3.0 million IU |
| 5-20 mL/min | 2.3 million IU |
| 0-5 mL/min | 2.0 million IU |
- Maintenance dosing bands are rounded off for simplified dosing. If more precise dosing is needed, contact the Clinical Pharmacologist on call
- Discard contents of leftover vials
- Monitoring: Renal function (colistin is nephrotoxic & neurotoxic)
| If you are uncertain about dose adjustment, or for haemodialysis dose adjustments, contact the Clinical Pharmacologist on call. |
References:
- Visser Kift E, Maartens G, Bamford C. Systematic review of the evidence for rational dosing of colistin. South African Medical Journal. 2014 Feb 27;104(3):183-186.
- Labuschagne Q, Schellack N, Gous A, et al. Colistin: Adult and paediatric guideline for South Africa, 2016. Southern African Journal of Infectious Diseases. 2016 Mar 4;31(1):3-7.
- Tsuji BT, Pogue JM, Zavascki AP, et al. International Consensus Guidelines for the Optimal Use of the Polymyxins. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. 2019 Jan;39(1):10-39.
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