What is the dose of colistin inhalation for neonates ?
Aerosolized colistin either as monotherapy or in combination with other IV antibiotics demonstrated potential for treating full-term and pre-term neonates with Acinetobacter baumannii (13 of the 16 neonates had multidrug-resistant isolates) ventilator-associated pneumonia in 2 retrospective studies. Neither clinical nor laboratory adverse events were reported. The dosage of colistin base was 4 mg/kg/dose aerosolized with an ultrasonic nebulizer for 15 minutes every 12 hours for a median of 9 days (4 to 14 days) in neonates on a ventilator while receiving concurrent IV antibiotics. All of the 16 neonates who received nebulized colistin cleared the A baumannii infection. Another regimen was colistimethate sodium 1 million international units (33.4 mg colistin base) monotherapy twice daily for an average of 9.1 days (4 to 22 days).
References:
- Kang CH, Tsai CM, Wu TH et al: Colistin inhalation monotherapy for ventilator-associated pneumonia of Acinetobacter baumannii in prematurity. Pediatr Pulmonol Apr, 2014; 49(4): 381-388.
- Nakwan N, Wannaro J, Thongmak T et al: Safety in treatment of ventilator-associated pneumonia due to extensive drug-resistant Acinetobacter baumannii with aerosolized colistin in neonates: a preliminary report. Pediatr Pulmonol Jan, 2011; 46(1): 60-66.
Inhalation: Use immediately after mixed. Do not use after 24 hours. In solution, colistimethate undergoes spontaneous hydrolysis to form its 2 active components polymyxin E1 (colistin A), which is toxic to the lungs, and polymyxin E2 (colistin B). Use after 24 hours can result in increased colistin concentration and the potential for increased lung toxicity.
Ref:
US Food and Drug Administration: Information for Healthcare Professionals: Colistimethate (marketed as COLY-MYCIN M(R) and generic products). US Food and Drug Administration, Rockville, MD, Jun28, 2007.