Intramuscular, IntravenousSusceptible Gram-negative infectionsAdult: Dosage is expressed in terms of colistin base activity (CBA) in mg; CBA 1 mg is equivalent to 30,000 international units or approx 2.4 mg colistimethate sodium (CMS). For acute or chronic infections: 2.5-5 mg/kg daily in 2-4 divided doses. Max: 5 mg/kg daily. Doses may be given via deep IM inj, IV inj or continuous IV infusion. For IV inj, give 1/2 of the total daily dose (reconstituted solution) over 3-5 minutes 12 hourly. For continuous IV infusion, give 1/2 of the total daily dose (reconstituted solution) over 3-5 minutes, then give the remaining 1/2 of the total daily dose (diluted solution) 1-2 hours after the initial dose via slow IV infusion over the next 22-23 hours. Dosage expressions and recommendations may vary among countries and individual products (refer to specific product guidelines).
Child: Same as adult dose.
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Dosage is expressed in terms of CBA in mg; CBA 1 mg is equivalent to 30,000 international units or approx 2.4 mg CMS.
| CrCl (mL/min) |
Dosage |
| 10-29 |
1.5 mg/kg 36 hourly. |
| 30-49 |
2.5 mg/kg daily as a single dose or in 2 divided doses. |
| 50-79 |
2.5-3.8 mg/kg daily in 2 divided doses. |
Doses may be given via deep IM inj, IV inj or continuous IV infusion; adjust the infusion rate based on the degree of renal impairment. Dosage expressions and recommendations may vary among countries and individual products (refer to specific product guidelines).
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Powder for solution for IV or IM inj: Reconstitute each vial labelled as 150 mg CBA with 2 mL sterile water for inj to achieve a concentration of 75 mg CBA/mL. Gently swirl to avoid frothing. IV infusion: May further dilute half of the daily dose using a compatible solution (e.g. NaCl 0.9% solution, dextrose 5% in water, lactated Ringer's solution).
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Colistin base and colistimethate strengths are not interchangeable; verify the prescribed dosage expression before use. Renal impairment. Children. Pregnancy and lactation.
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Significant: Fungal or bacterial superinfection, including pseudomembranous colitis and Clostridioides difficile-associated diarrhoea (prolonged use); nephrotoxicity (dose-dependent); transient and reversible neurological disturbances (e.g. paraesthesia, vertigo, slurred speech); respiratory arrest.
Gastrointestinal disorders: Gastrointestinal upset.
General disorders and administration site conditions: Fever.
Investigations: Increased BUN or creatinine; decreased urine output.
Nervous system disorders: Dizziness, seizures.
Respiratory, thoracic and mediastinal disorders: Respiratory distress, apnoea.
Skin and subcutaneous tissue disorders: Pruritus, urticaria, rash.
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This drug may cause dizziness or other neurological disturbances; if affected, do not drive or operate machinery.
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Perform culture and susceptibility tests; consult local institutional recommendations before treatment initiation due to antibiotic resistance risks. Monitor renal function (e.g. serum creatinine, BUN, urine output) and colistin serum concentrations. Assess for signs and symptoms of neurotoxicity or nephrotoxicity.
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Concomitant use with aminoglycosides and polymyxin B may cause additive nephrotoxic or neurotoxic effects. Amphotericin B, cefalotin and vancomycin may enhance the nephrotoxic effects of colistin. May potentiate the neuromuscular-blocking effects of curariform muscle relaxants (e.g. tubocurarine), ether, sodium citrate and succinylcholine.
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Description: Overview: Colistin is a polymyxin antibiotic. It is available in different expressions of dose in terms of potency. Dosage expression of colistin base or colistimethate sodium varies depending on the country of origin and specific product formulation; the following conversion table is provided for reference only, with values considered nominal and approximate.
| Colistin Base Activity (mg) |
Colistimethate Sodium (units) |
Colistimethate Sodium (mg) |
| 34 |
1,000,000 |
80 |
| 67 |
2,000,000 |
160 |
| 100 |
3,000,000 |
240 |
| 150 |
4,500,000 |
360 |
| 200 |
6,000,000 |
480 |
| 300 |
9,000,000 |
720 |
| 400 |
12,000,000 |
960 |
Mechanism of Action: Colistin acts as a cationic detergent and damages the cytoplasmic membrane of the bacteria, thereby causing leakage of intracellular substances and cell death. Pharmacokinetics: Absorption: Time to peak plasma concentration: IV: 2 hours (range: 1-4 hours). Distribution: Crosses the placenta and enters breast milk. Volume of distribution: 12.4 L (IV). Plasma protein binding: 50%. Excretion: Mainly via urine (as unchanged drug). Elimination half-life: 2-3 hours.
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Intact vials: Store between 20-25°C. Reconstituted solution: Store between 2-8°C or 20-25°C for up to 7 days. Storage recommendations may vary between individual products (refer to specific product guidelines).
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J01XB01 - colistin ; Belongs to the class of polymyxins. Used in the systemic treatment of infections.
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Brayfield A, Cadart C (eds). Colistin Sulfate. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 06/06/2025. Colistimethate Sodium Injection, Powder, Lyophilized, for Solution (Heritage Pharmaceuticals Inc. d/b/a Avet Pharmaceuticals Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 06/06/2025. Colistimethate Sodium. UpToDate Lexidrug, AHFS DI (Adult and Pediatric) Online. American Society of Health-System Pharmacists, Inc. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 06/06/2025. Colistimethate, Colistin, Polymyxin E. Gold Standard Drug Database in ClinicalKey [online]. Elsevier Inc. https://www.clinicalkey.com. Accessed 06/06/2025. Colistimethate. UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 06/06/2025. Coly-Mycin M Injection (Endo USA, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 06/06/2025. Link Pharmaceuticals Ltd. Colistin-Link 150 mg/2 mL Powder for Injection data sheet 23 January 2019. Medsafe. http://www.medsafe.govt.nz. Accessed 06/06/2025.
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