Kolneb (Colistimethate Sodium)

• Kolneb is used to treat respiratory infections caused by Gram‑negative bacteria, particularly in the cystic fibrosis pathway.
• Chronic lung infection in cystic fibrosis: Reduces bacterial load of Pseudomonas aeruginosa and helps preserve lung function.
• Other respiratory infections requiring inhaled colistin therapy: Provides targeted antibacterial activity directly to the airways.
• Ventilator‑associated pneumonia in intubated patients: Delivers colistin to the lungs to treat Pseudomonas aeruginosa infections.

• Colistimethate sodium binds to lipopolysaccharides and phospholipids in the outer membrane of Gram‑negative bacteria, disrupting membrane integrity. This interaction leads to increased permeability, leakage of intracellular contents, and ultimately bacterial cell death, providing a bactericidal effect in the respiratory tract.

Kolneb may cause a range of adverse reactions, which are categorized by frequency and severity.

Common Side Effects

• Cough or throat irritation during inhalation.
• Bronchospasm or wheezing.
• Taste disturbance or metallic taste.
• Nausea or mild headache.

Serious or Rare Side Effects

• Severe bronchospasm or respiratory distress.
• Anaphylactic or severe allergic reactions.
• Nephrotoxicity from systemic absorption.
• Neurotoxicity, including seizures or altered mental status.

Kolneb should be used with caution, and patients should be monitored for specific safety considerations.

• Renal function monitoring: Assess baseline and periodic kidney function due to potential nephrotoxicity.
• Hypersensitivity assessment: Avoid use in patients with known allergy to colistimethate sodium or other polymyxins.
• Respiratory status: Monitor for bronchospasm, especially in patients with reactive airway disease.
• Concomitant nephrotoxic agents: Avoid or adjust dose when used with other nephrotoxic drugs.
• Dose adjustment in renal impairment: Tailor therapy based on renal function.
• Store at 2-8°C: Keep refrigerated, protect from light, do not freeze or shake.

Kolneb can interact with other medicines, requiring attention to avoid or monitor co‑administration.

Major Interactions (Avoid)

• Concurrent nephrotoxic antibiotics (e.g., aminoglycosides, vancomycin).
• Neuromuscular blocking agents, which may potentiate respiratory muscle weakness.
• Other polymyxin antibiotics, increasing risk of toxicity.

Moderate Interactions (Monitor Closely)

• Cyclosporine or tacrolimus, which may increase neurotoxic risk.
• Loop diuretics, potentially enhancing renal effects.
• Non‑steroidal anti‑inflammatory drugs (NSAIDs), may affect renal function.
• Inhaled corticosteroids, monitor for additive respiratory irritation.