Polymyxins

Prescribing Notes

Colistimethate sodium is active against Gram-negative organisms including Pseudomonoas aeruginosa, Acinetobacter baumanii and Klebsiella pneumoniae. It is not absorbed by mouth so must be given by injection, but more often is used as an inhalation.

For nebulisation in patients with Cystic Fibrosis (CF)

Inpatients

New initiations of the drug: Must be under the direction of the specialist CF centre.

Patients already receiving the drug under a specialist CF centre: Patients should be encouraged to bring in their supply from home. If that is not possible, then the Trust should supply so that the patient does not run out. On discharge, Trusts should not need to supply, as the patient should have their supplies at home under the specialist centre arrangement

Outpatients

All supplies to come from the specialist CF centre that the patient is under.

Colistin, gentamicin and tobramycin nebs are also approved for adult patients with bronchiectasis (non-CF) in line with BTS guidelines. For specialist respiratory initiation under microbiology recommendation only. Colistin is the 1st line choice.