NEONATAL MEDICATION GUIDELINE
Colistin
Scope (Staff): Nursing, Medical and Pharmacy Staff
Scope (Area): KEMH NICU, PCH NICU, NETS WA
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Preparation & Side Effects &
Dose Monitoring
Administration Interactions
Restrictions
Neonatal: Non-Formulary - IPA Required
In order not to create unnecessary delays in treatment in uncommon circumstances, medications not listed in the
formulary but used in paediatrics may be used in the neonatal setting when under the direction of both a Specialist
Consultant and a Neonatologist.
Paediatric Formulary: Highly Restricted
Restricted to prescribing by or in consultation with a Clinical Microbiologist or Infectious Disease Physician PRIOR
to initiation of therapy
HIGH RISK Medication
Description
Antibacterial
Presentation
Vial: 150mg powder for injection
(contains colistimethate sodium equivalent to 150 mg of colistin)
Storage
Vial: store at room temperature, below 25°C
Reconstituted solution: stable for 24 hours at 2 – 8°C. Do not freeze
Dose
Dosing of colistin is complex and not routinely used in neonates, seek advice from
Infectious Disease or Microbiology consultants
Colistin
Gram-negative infections
IV: 1.7mg/kg/dose every 8 hours
Dose Adjustment
Renal Impairment:
Should be avoided in renal impairment due to an increased risk of toxicity and worsening renal
impairment.
For patients with any degree of renal impairment, consider using a slower rate of infusion (e.g.
over 1 to 2 hours).
Preparation
IV infusion
Step 1 Reconstitution: Reconstitute the vial with 2mL of Water for Injections, swirl gently to
avoid foaming; do not shake the vial. Concentration = 75mg/mL
Step 2 Dilution: Dilute 2mL (150mg) to 30mL with a compatible fluid. Concentration = 5mg/mL
Administration
IV infusion
Infuse dose over 30 minutes
Compatible Fluids
Sodium Chloride 0.9%, Glucose 5%
Refer to IV Compatibility Chart in Neonates for compatibility information or refer to the Pharmacy
Department
Side Effects
Common: nephrotoxicity, neurotoxicity
Serious: hypersensitivity reactions, apnoea, sensory disorder
Monitoring
Renal function, urine output, full blood picture
Neonatal Medication Guideline Page 2 of 4
Colistin
Comments
Each vial contains 1.09 mmol of sodium
Doses are expressed in terms of colistin base
pH = 7 – 8 when reconstituted
Related Policies, Procedures & Guidelines
WNHS Clinical Practice Guidelines:
Neonatal Medication Guideline: Prescribing and Administration of Medications to Neonates
References
Australian Medicines Handbook. Colistin. In: Australian Medicines Handbook [Internet]. Adelaide
(South Australia): Australian Medicines Handbook; 2021 [cited 2021 Jun 04]. Available from:
https://amhonline.amh.net.au/
Society of Hospital Pharmacists of Australia. Colistin. In: Australian Injectable Drugs Handbook
[Internet]. [St Leonards, New South Wales]: Health Communication Network; 2021 [cited 2021
Jun 04]. Available from: http://aidh.hcn.com.au
Takemoto CK, Hodding JH, Kraus DM. Pediatric & neonatal dosage handbook with international
trade names index : a universal resource for clinicians treating pediatric and neonatal patients.
27th ed. Hudson (Ohio): Lexicomp; 2020.
Truven Health Analytics. Colistin. In: NeoFax [Internet]. Greenwood Village (CO): Truven Health
Analytics; 2021 [cited 2021 Jun 04]. Available from: https://neofax.micromedexsolutions.com/
Ilhan O, Bor M, Ozdemir SA, Akbay S, Ozer EA. Efficacy and Safety of Intravenous Colistin in
Very Low Birth Weight Preterm Infants. Paediatr Drugs. 2018 Oct;20(5):475-481. doi:
10.1007/s40272-018-0301-5. PMID: 30073562
Neonatal Medication Guideline Page 3 of 4
Colistin
Keywords Colistin, colistimethate sodium
Document Head of Department - Neonatology
Owner:
Author/ KEMH & PCH Pharmacy/Neonatology Directorate
Reviewer
Version July 2021 – inaugural guideline
Info:
Date First 16/07/2021 Last Reviewed: 16/07/2021 Review Date: 16/07/2024
Issued:
Endorsed Medicines and Therapeutics Committee, Antimicrobial Date: 27/07/2021
by: Stewardship Sub-Committee, Neonatal Coordinating
Group
NSQHS
Standards Std 1: Clinical Governance Std 5: Comprehensive Care
Applicable:
Std 2: Partnering with Consumers Std 6: Communicating for Safety
Std 3: Preventing and Controlling Std 7: Blood Management
Healthcare Associated Infection
Std 4: Medication Safety Std 8: Recognising and
Responding to Acute Deterioration
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Access the current version from WNHS HealthPoint.
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© Women and Newborn Health Service 2020
Copyright of this material is vested in the State of Western Australia unless otherwise indicated. Apart
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Neonatal Medication Guideline Page 4 of 4
