Kolneb (Colistimethate Sodium)

• Kolneb is a polymyxin antibiotic used to manage chronic Gram‑negative bacterial infections of the respiratory tract.
• Cystic fibrosis: reduces chronic Pseudomonas aeruginosa lung infection burden.
• Non‑cystic fibrosis bronchiectasis: helps control chronic Pseudomonas aeruginosa colonisation.
• Ventilator‑associated pneumonia: provides adjunctive inhaled therapy against Pseudomonas aeruginosa.

• Colistimethate Sodium binds to the lipopolysaccharide layer of Gram‑negative bacterial cell membranes, disrupting membrane integrity. This interaction increases permeability, leading to leakage of intracellular contents and bacterial cell death, thereby reducing the bacterial load in the airways.

Kolneb may cause a range of respiratory and systemic reactions.

Common Side Effects

• Cough or throat irritation.
• Bronchospasm or wheezing.
• Dysphonia (hoarse voice).
• Nausea or mild gastrointestinal upset.
• Headache.
• Transient fever.

Serious or Rare Side Effects

• Acute respiratory distress or severe bronchospasm.
• Anaphylactic reaction or severe hypersensitivity.
• Nephrotoxicity due to systemic absorption.
• Neurotoxicity, including paresthesia or seizures.
• Hemoptysis.
• Persistent or worsening lung infection.

• When prescribing Kolneb, clinicians should consider several safety measures.
• Monitor renal function: assess for potential nephrotoxicity, especially with prolonged use.
• Assess for hypersensitivity: discontinue if signs of allergic reaction appear.
• Use cautiously in pre‑existing lung disease: patients with severe airway hyperreactivity may experience bronchospasm.
• Avoid concurrent nephrotoxic agents: limit use with aminoglycosides or loop diuretics.
• Pregnancy and lactation: risk unknown; weigh benefits against potential fetal or infant exposure.
• Store at room temperature: keep in original container, protect from moisture and light.

Colistimethate Sodium can interact with other medications, requiring careful management.

Major Interactions (Avoid)

• Aminoglycosides: additive nephrotoxicity.
• Loop diuretics: increased risk of renal impairment.
• Vancomycin: overlapping nephrotoxic potential.
• Nephrotoxic chemotherapeutics (e.g., cisplatin): heightened renal risk.
• High‑dose NSAIDs: may exacerbate kidney injury.

Moderate Interactions (Monitor Closely)

• Bronchodilators: may provoke bronchospasm when combined.
• Systemic corticosteroids: can mask infection signs.
• Other inhaled antibiotics: potential additive respiratory toxicity.
• Antacids containing magnesium or aluminum: may affect aerosol stability.
• Warfarin: monitor INR as infection control may alter coagulation status.