What are the effects of Colistin (Colistimethate) nebulizations?

From the Guidelines

Colistin nebulizations are a recommended treatment option for respiratory infections caused by multidrug-resistant gram-negative bacteria, particularly Pseudomonas aeruginosa, with a recommended dosage of 2 million IU every 8 or 12 h 1. The use of colistin nebulizations has been shown to be effective in improving lung function and reducing the number of hospital admissions in patients with cystic fibrosis and chronic P. aeruginosa infection 1. Key considerations for the use of colistin nebulizations include:

• The selection of colistin should be based on susceptibility results 1
• Nebulized antibiotics should be delivered using ultrasonic or vibrating plate nebulizers 1
• Patients should use a bronchodilator to prevent bronchospasm, and the first dose should be given under medical supervision to monitor for potential adverse reactions
• Common side effects include cough, bronchospasm, and throat irritation
• Regular monitoring of respiratory function and bacterial cultures is recommended to assess treatment efficacy
• Proper nebulizer cleaning between uses is essential to prevent reinfection or contamination It is also important to note that nebulized antibiotics should not be used in patients with A. baumannii colonization 1, and that the optimal dose of nebulized colistin has not been established, but higher doses can be used in non-resolving cases 1. Some of the benefits of using colistin nebulizations include:
• Improved lung function
• Reduced number of hospital admissions
• Effective treatment option for patients with multidrug-resistant gram-negative bacteria
• Can be used in combination with intravenous antimicrobial therapy However, it is also important to consider the potential risks and limitations of using colistin nebulizations, including:
• Potential for bronchospasm and other respiratory side effects
• Need for proper nebulizer cleaning and maintenance to prevent reinfection or contamination
• Limited data on the optimal dose and duration of treatment
• Potential for the development of resistance to colistin and other antibiotics.

From the FDA Drug Label

PRECAUTIONS General ...

There is no information about nebulization in the provided text.

The FDA drug label does not answer the question.

From the Research

Effects of Colistin (Colistimethate) Nebulizations

• Colistin nebulizations have been shown to achieve higher concentrations in lung fluids compared to intravenous administration, with negligible plasma exposure 2, 3.
• The use of nebulized colistimethate sodium (CMS) has been found to be beneficial in treating lower respiratory tract infections caused by multidrug-resistant Gram-negative bacteria (GNB) 3.
• Inhaled colistin has been used as monotherapy or in combination with systemic antibiotics to treat respiratory tract infections, including pneumonia and ventilator-associated tracheobronchitis 4, 5, 6.
• The effectiveness of inhaled colistin has been demonstrated in various studies, with clinical success rates ranging from 59% to 70.4% and eradication of Gram-negative bacteria in 71.3% of cases 5, 6.
• However, the use of inhaled colistin is not without risks, and renal injury has been reported in some patients, particularly those receiving concomitant intravenous colistin 6.

Pharmacokinetics and Dosage

• The dosage of inhaled colistin varies, with some studies using daily doses of 200,000 international units/24h 3 and others using total daily doses of 6 ± 3 million international units divided into 2-3 doses 6.
• The duration of therapy also varies, ranging from 11 ± 6 days 6 to several weeks.
• The conversion of CMS to colistin is slow, and a loading dose may be necessary to achieve effective concentrations within a reasonable time period 2.

Clinical Applications

• Inhaled colistin may be considered as salvage therapy as an adjunct to intravenous administration for the treatment of patients with nosocomial pneumonia due to multidrug-resistant Gram-negative pathogens 6.
• It may also be used as monotherapy in patients with chronic infections with P. aeruginosa in cystic fibrosis patients, or in combination with systemic antibiotics in patients with hospital/ventilator-acquired pneumonia (HAP/VAP) 4.