目前的Guideline已經有修改過了,請參閱

Abx guide:

 

USUAL ADULT DOSING 

 

  • 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。

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 CMS,也就是相當於1vialColistin<66.8mg>

 

還有一點,現在臨床上面常用的吸入型劑量是0.51vialq12h

 

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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