Colistimethate Sodium: Brands, Price & Uses in Bangladesh

Serious Infections Caused by Multidrug-Resistant Gram-Negative Bacteria

Colistimethate Sodium is an established, FDA-approved treatment for acute and chronic infections caused by susceptible strains of gram-negative bacilli, particularly Pseudomonas aeruginosa, when other, less toxic antibiotics are ineffective or contraindicated. It is also active against susceptible strains of Escherichia coli, Klebsiella pneumoniae, and Enterobacter aerogenes.

Colistimethate Sodium is generally reserved as a last-line agent for infections such as:

• Hospital-acquired and ventilator-associated pneumonia caused by multidrug-resistant (MDR) gram-negative organisms
• Bloodstream infections (bacteremia) due to susceptible MDR gram-negative pathogens
• Complicated urinary tract infections caused by susceptible organisms
• Skin and soft-tissue infections due to susceptible gram-negative bacteria

Guideline-Supported and Adjunct Uses

In combination with other active antibiotics, Colistimethate Sodium (given intravenously and, in some regimens, by inhalation) is used per infectious-disease guidelines for infections caused by carbapenem-resistant Enterobacterales, MDR Acinetobacter baumannii, and MDR Pseudomonas aeruginosa, particularly when few other treatment options remain.

Off-Label / Adjunctive Inhaled Use

Nebulized (inhaled) Colistimethate Sodium is used off-label, usually as adjunctive therapy alongside systemic antibiotics, in patients with cystic fibrosis or ventilator-associated pneumonia caused by susceptible gram-negative organisms. This route does not replace systemic therapy for bloodstream or deep-tissue infection.

Colistimethate Sodium should be used only for infections proven or strongly suspected to be caused by susceptible bacteria; it is not appropriate for infections caused by gram-positive organisms, most strains of Proteus or Serratia, or anaerobes.

Dosing of Colistimethate Sodium is expressed in terms of colistin base activity (CBA) and must be individualized based on the severity of infection, body weight, and renal function. Colistimethate Sodium should be administered only under close medical/hospital supervision, with regular monitoring of renal function.

Adults and Adolescents — Normal Renal Function

Dose Adjustment in Renal Impairment

Dosing in patients on hemodialysis or continuous renal replacement therapy must be individualized by a specialist, as extracorporeal therapy can remove a variable amount of drug.

Pediatric Dosing

Pediatric patients with normal renal function are generally dosed similarly on a mg/kg basis to adults (see Pediatric Uses section); dosing must be individualized by a pediatric specialist.

Antibiotic stewardship: Take/receive Colistimethate Sodium exactly as prescribed by your physician; do not stop, extend, skip doses, or share this medicine with others without medical advice. Colistimethate Sodium is generally reserved for infections resistant to other antibiotics and should never be used inappropriately, as this contributes to antibiotic resistance.

Like all medicines, Colistimethate Sodium can cause side effects, though not everyone experiences them. Serious risks (nephrotoxicity, neurotoxicity) are discussed further in Precautions and Warnings.

Common Side Effects

• Gastrointestinal upset (nausea, vomiting, diarrhea)
• Skin itching (pruritus), rash, or hives (urticaria)
• Fever
• Pain, redness, or irritation at the injection site

Less Common but Serious Side Effects

• Kidney impairment — decreased urine output, rising blood urea nitrogen (BUN) and creatinine (see Precautions and Warnings)
• Neurological symptoms — numbness or tingling around the mouth or in the extremities, dizziness, vertigo, slurred speech, visual disturbance, confusion, and, rarely, seizures or neuromuscular blockade leading to muscle weakness or breathing difficulty (see Precautions and Warnings)
• Electrolyte disturbances, including low potassium and metabolic alkalosis (pseudo-Bartter-like syndrome)
• Severe allergic reaction (anaphylaxis) — swelling of the face/throat, difficulty breathing, severe rash
• Diarrhea caused by Clostridioides difficile, which can occur during or for several weeks after antibiotic treatment

Seek urgent medical attention if breathing difficulty, severe weakness, marked decrease in urine output, or signs of a severe allergic reaction occur during treatment with Colistimethate Sodium.