Table 3.

Suggested loading dose and daily maintenance doses of CMSa

DoseCategory of critically ill patientDosing suggestions
Loading doseAll patient categoriesEquation 9:
Loading dose of CBA (mg) = colistin Css,avg targetb × 2.0 × body wt (kg).c See caveat in footnote c. First maintenance dose should be given 24 h later.
Maintenance doseNot on renal replacementEquation 10:
Daily dose of CBA (mg) = colistin Css,avg targetb × (1.50 × CrCL + 30).d Recommended dosage intervals based on CrCL: <10 ml/min/1.73 m2, every 12 h, 10-70 ml/min/1.73 m2 every 12 (or 8) h, and >70 ml/min/1.73 m2 every 12 (or 8) h. See important caveat in footnote d.
Receiving intermittent hemodialysisDaily dose of CBA on a non-HD day to achieve each 1.0-mg/liter colistin Css,avg targetb = 30 mge.
Supplemental dose of CBA on a HD dayf: add 50% to the daily maintenance dose if the supplemental dose is administered during the last hour of the HD session, or add 30% to the daily maintenance dose if the supplemental dose is administered after the HD session. Twice-daily dosing is suggested.
Receiving continuous renal replacementDaily dose of CBA to achieve each 1.0-mg/liter colistin Css,avg target = 192 mg.g Doses may be given every 8-12 h.
  • a Expressed as mg of colistin base activity (CBA) for various categories of critically ill patients. The suggested maintenance daily dose would commence 24 h after administration of a CMS loading dose. Example: To target a colistin Css,avg of 2.5 mg/liter, a 55-kg patient with a CrCL of 40 ml/min/1.73 m2 would receive a loading dose of 275 mg CBA followed in 24 h by commencement of a maintenance regimen of 225 mg CBA/day in 2 to 3 equally divided doses.

  • b Colistin Css,avg target is expressed in mg/liter. This target should be based on MIC, site, and severity of infection.

  • c Use the lower of ideal or actual body weight, expressed in kg. At this time, we suggest caution in the use of a loading dose greater than 300 mg CBA (see the text for more details).

  • d Based upon the population PK analysis for 101 critically ill patients not on continuous renal replacement therapy. Colistin Css,avg target expressed in mg/L. Creatinine clearance (CrCL) expressed in ml/min/1.73 m2. Although the Jelliffe equation was used to estimate CrCL in this study, other means (e.g., Cockcroft and Gault equation) may be used to estimate CrCL which would then be normalized to a body surface area of 1.73 m2. See text for caveat regarding use of the algorithm in patients with CrCL values > 70 ml/min/1.73 m2 or when targeting a “high” colistin Css,avg, both being circumstances where the algorithm may predict daily doses of CBA substantially greater than the current upper limit in the product label.

  • e Based upon use of equation 10 and setting CrCL to zero.

  • f Supplemental dose of CMS to achieve a similar colistin Css,avg on a HD day as occurs on a non-HD day. It is assumed that the hemodialysis session occurs toward the end of a CMS dosage interval.

  • g Based on the population PK analysis for 4 critically ill patients receiving continuous renal replacement therapy.