Natrijev Kolistimetat Accord (Colistimethate Sodium)

Colistimethate Sodium is employed to manage severe infections caused by Gram‑negative bacteria, especially when resistance limits other options.

• Pseudomonas aeruginosa infections: effective therapy for severe hospital‑acquired infections such as pneumonia and bloodstream infections.
• Complicated urinary tract infections: used when the pathogen is susceptible and alternative agents are unsuitable.
• Ventilator‑associated pneumonia: provides coverage for multidrug‑resistant Gram‑negative organisms in critically ill patients.

• Colistimethate Sodium binds to the lipopolysaccharide layer of Gram‑negative bacterial cell membranes, displacing calcium and magnesium ions. This interaction disrupts membrane integrity, increases permeability, and leads to leakage of intracellular contents, ultimately causing bacterial cell death.

Colistimethate Sodium may cause a range of adverse reactions, from mild to severe.

Common Side Effects

• Nephrotoxicity: elevated serum creatinine and reduced renal function.
• Neurotoxicity: paresthesia, dizziness, or confusion.
• Rash or pruritus: mild skin irritation.
• Fever: transient temperature elevation.
• Nausea and vomiting: gastrointestinal upset.
• Diarrhea: loose stools.

Serious or Rare Side Effects

• Anaphylaxis: severe allergic reaction with airway compromise.
• Stevens‑Johnson syndrome: extensive skin and mucous membrane involvement.
• Neuromuscular blockade: respiratory muscle weakness, especially with concomitant neuromuscular blockers.
• Ototoxicity: hearing loss or tinnitus.
• Severe electrolyte disturbances: hyperkalemia or hypocalcemia.
• Hemolysis: destruction of red blood cells.

Colistimethate Sodium requires careful monitoring and specific safety measures.

• Renal function monitoring: assess serum creatinine and urine output before and during therapy.
• Neuromuscular disease caution: avoid use in patients with myasthenia gravis or other neuromuscular disorders.
• Concomitant ototoxic drugs: limit simultaneous use of aminoglycosides or loop diuretics.
• Pregnancy and lactation: safety data are limited; use only if potential benefit justifies the risk.
• Dose adjustment in severe renal impairment: modify dosing according to renal function.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze.

Colistimethate Sodium can interact with several drug classes, affecting safety or efficacy.

Major Interactions (Avoid)

• Aminoglycosides: additive nephrotoxicity and neurotoxicity.
• Neuromuscular blocking agents: increased risk of respiratory paralysis.
• Loop diuretics: heightened renal toxicity.

Moderate Interactions (Monitor Closely)

• Non‑steroidal anti‑inflammatory drugs (NSAIDs): may exacerbate renal impairment.
• Carbapenems: potential antagonism reducing antibacterial effect.
• Rifampin: may induce hepatic enzymes, lowering colistin levels.