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Adverse Effects of Sodium Colistimethate: Manifestations and Specific Reaction Rates During 317 Courses of Therapy

JAN KOCH-WESER, M.D.; VICTOR W. SIDEL, M.D.; ELIZABETH B. FEDERMAN, R.N.; PAULA KANAREK, M.A.; DIANA C. FINER, B.A.; and ANN E. EATON, M.Ed.
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Dr. Koch-Weser was supported in part by a Clinical Pharmacology Award, Burroughs Wellcome Fund, Tuckahoe, N.Y. Dr. Sidel was supported by a Faculty Fellowship of the Milbank Memorial Fund.

▸Requests for reprints should be addressed to Jan Koch-Weser, M.D., Massachusetts General Hospital, Boston, Mass. 02114


Boston, Massachusetts


Ann Intern Med. 1970;72(6):857-868. doi:10.7326/0003-4819-72-6-857
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Two hundred and eighty-eight hospitalized patients were monitored during and after 317 courses of sodium colistimethate therapy to determine incidence and manifestations of adverse reactions. Adverse renal reactions occurred during 20.2% of colistin utilizations and were generally reversible. Acute tubular necrosis occurred during 1.9% of utilizations, manifestations of colistin neurotoxicity developed during 7.3%. Respiratory insufficiency and apnea were seen in 2.1% of patients. Adverse effects of colistin therapy contributed to the death of 13 (4.5%) patients. Adverse effects of colistin therapy contributed to the death of 13 (4.5%) patients treated with the drug. Sixty-four percent of adverse reactions to colistin became manifest during the first 4 days of therapy, and 95% occurred in patients who received no more than the recommended dose. For any given mean daily dose per pound, reaction rates increased markedly with patient weight. Colistin dosage proportional to the square root of patient weight might avoid the excess reaction rate in heavy patients and produce more effective blood levels in light patients.

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[Practical guideline for the use of colistin]. Ned Tijdschr Geneeskd 2014;158(0):A7445.
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