Kolneb (Colistimethate Sodium)

Kolneb is a polymyxin antibiotic used to manage chronic bacterial airway infections in cystic fibrosis.

• Chronic Pseudomonas aeruginosa lung infection in cystic fibrosis: reduces bacterial burden and helps preserve lung function.
• Persistent airway colonisation by Pseudomonas aeruginosa in cystic fibrosis: aids in long‑term suppression of the pathogen.
• Multidrug‑resistant Gram‑negative respiratory infections in cystic fibrosis: provides an alternative option when other agents fail.

• Colistimethate Sodium binds to lipopolysaccharides and phospholipids in the outer membrane of Gram‑negative bacteria, especially Pseudomonas aeruginosa. This interaction disrupts membrane integrity, increases permeability, and leads to leakage of cellular contents, ultimately causing bacterial cell death.

Kolneb may cause a range of adverse reactions, most of which are related to its local pulmonary administration and systemic absorption.

Common Side Effects

• Cough: irritation of the airways may provoke a persistent cough.
• Bronchospasm: transient narrowing of the bronchial tubes can occur during inhalation.
• Throat irritation: patients often report soreness or a burning sensation in the throat.
• Taste disturbance: a metallic or salty taste is frequently noted.

Serious or Rare Side Effects

• Anaphylaxis: severe allergic reaction requiring immediate medical attention.
• Respiratory failure: marked decline in breathing function, especially in vulnerable patients.
• Nephrotoxicity: systemic absorption can impair kidney function.
• Ototoxicity: potential hearing loss or balance disturbances, particularly with high cumulative exposure.

Before prescribing Kolneb, clinicians should evaluate patient‑specific risk factors and monitor for potential complications.

• Renal function monitoring: assess serum creatinine and eGFR regularly due to possible nephrotoxicity.
• Auditory assessment: perform baseline and periodic hearing tests to detect ototoxic effects.
• Bronchospasm risk: pre‑treat with bronchodilators in patients with reactive airway disease.
• Hepatic impairment: use caution in patients with cystic fibrosis‑related liver disease.
• Store at room temperature: keep in the original container, protect from moisture and light.

Colistimethate Sodium can interact with several drug classes, influencing safety and efficacy.

Major Interactions (Avoid)

• Neuromuscular blocking agents (e.g., vecuronium): increased risk of muscle weakness and respiratory compromise.
• Aminoglycosides (e.g., gentamicin): additive nephrotoxicity and ototoxicity.

Moderate Interactions (Monitor Closely)

• Loop diuretics (e.g., furosemide): may enhance renal toxicity; monitor renal parameters.
• Non‑steroidal anti‑inflammatory drugs (NSAIDs): potential for increased kidney injury; assess renal function.
• Rifampin: may reduce colistin plasma levels, diminishing efficacy; consider therapeutic drug monitoring.