目前的Guideline已經有修改過了，請參閱
Abx guide:
- Severe infections caused by MDR gram-negative organisms: 5mg/kg x 1 (loading dose) then 2.5mg/kg q 12h.
- Loading dose based on a study by Dalfino[Dalfino, 2012].
- PK modeling suggest the need for a loading dose in ICU pts (5-7.5mg/kg)[Plachouras, 2009]. Without loading dose, therapeutic concentrations reached at 24hrs (MIC = 1) and 60hrs (MIC = 2)
- Inhalation: 75mg in 3ml NS via nebulizer twice daily.
- Note: ask pharmacy to reconstitute drug shortly prior to inhalation, since otherwise prodrug colistimethate may convert to biologically active colistin which if given significantly by aerosol route may lead to ARDS.
- Intraventricular or intrathecal colistin: 5 mg q12h, up to 10 mg q12h[Falagas, 2007].
- Otic preparation: 1-2 drops q8-6h to affected ear.
- Unit conversion information:
- Colistin sulfate (used for MIC testing): 1mg = 30,000 units.
- Colistin methanesulfonate (aka CMS, colistimethate, sulphomethate): CMS 2.5mg = 30,000 units.
RENAL DOSING
DOSING FOR GLOMERULAR FILTRATION OF 50-80
5mg/kg x 1 loading dose in critically ill patients, then 2.5 mg/kg IV q12h.
DOSING FOR GLOMERULAR FILTRATION OF 10-50
5mg/kg x 1 loading dose in critically ill patients, then for GFR 20-50 ml/min: 2.5-3.8 mg/kg/day divided in two doses; for GFR 5-20 ml/min: 2.5 mg/kg q 24h.
DOSING FOR GLOMERULAR FILTRATION OF <10 ML/MIN
Limited data. Consider 5mg/kg x 1 loading dose in critically ill patients, then 1.5mg/kg/d (approx 30% of daily dose) q24h.
DOSING IN HEMODIALYSIS
Limited data. Consider 5mg/kg x 1 loading dose, then 1.5mg/kg/d (approx 30% of daily dose) q24h. Conflicting data on drug removal during HD. On days of HD, dose post-HD.
DOSING IN PERITONEAL DIALYSIS
1.5mg/kg/d (approx 30% of daily dose) q24h. No supplement dose required, not removed in PD.
DOSING IN HEMOFILTRATION
Limited data. Consider 5mg/kg x 1 loading dose, then CVVHD with 1L/hr dialysis flow rate: 2.5 mg/kg q24h (2.5 mg/kg q12h can be considered in severe infections); 5mg/kg x 1 loading dose, then CVVHD with >1L/hr dialysis flow rate: 2.5 mg/kg q12h.
CVVH: limted data. Consider 5mg/kg load, then 2.5 mg/kg q48h.
之前跟大家提過80mg的版本，不過現在能見到的，是台灣東洋的66.8mg，所以就產生了劑量換算的問題，因此我聯絡過廠商，並將正確的資料整理在下面。
Colistin 劑量方面有些用mg，有些用IU，搞不清楚，廠商建議的換算方式：
1.Colimycin裡面裝的是Colistimethate Sodium (CMS)，
CMS打到體內才會有部分比率轉換成具殺菌力的Colistin base
2. 單位換算：
Colistin base:CMS = 1mg : 2.4mg
1mg CMS = 12,500 IU
1mg Colistin base = 30,000 IU
上面寫太複雜，看不懂吧，那就化繁為簡：
其實目前台灣東洋的Colistin 66.8mg也可以標示為Colistimethate sodium 160mg，也就是文獻中所寫的劑量。
所以給藥的時候就需要微調一下：
不過臨床上的醫師是建議用IU去算比較準
|
給藥方式 |
腎功能 |
劑量 |
|
頻率 |
|
IV |
正常範圍 |
1Vial |
2M IU |
q8h |
|
CCR>50-90 |
1vial |
2M IU |
q12h |
|
|
CCR=10-50 |
1vial |
2M IU |
q24h |
|
|
CCR<10 |
1vial |
2M IU |
q36h |
|
|
洗腎候補劑量 |
0.5vial |
1M IU |
|
|
|
inhalation |
|
1vial |
|
q12h（三天） |
另外
CVVH的病患使用劑量是2.5mg/kg q48h（這裡是指CMS，以60kg的病患來說，就是需要150 mg 的CMS，也就是相當於1vial的Colistin<66.8mg>
還有一點，現在臨床上面常用的吸入型劑量是0.5～1vial，q12h。
附上一張廠商給的小卡吧
相關連結：http://mulicia.pixnet.net/blog/post/14809254
關鍵字： colistin Colimycin polymyxin Coli 吸入 劑量調整
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