Xylistin

Xylistin is indicated for the treatment of acute or chronic infections caused by sensitive strains of certain gram-negative bacilli. It is particularly indicated in the infection caused by sensitive strains of Pseudomonas aeruginosa. Xylistin is not indicated for infections due to Proteus ... Read more Xylistin is indicated for the treatment of acute or chronic infections caused by sensitive strains of certain gram-negative bacilli. It is particularly indicated in the infection caused by sensitive strains of Pseudomonas aeruginosa. Xylistin is not indicated for infections due to Proteus or Neisseria. Xylistin is very effective in the treatment of infections due to the following gram-negative organisms: Enterobacter aerogenes, Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa.

Colistimethate is a surface active agent which penetrates into and disrupts the bacterial cell membrane. Colistimethate is polycationic and has both hydrophobic and lipophilic moieties. It interacts with the bacterial cytoplasmic membrane, changing its permeability. This effect is bactericidal. There is also evidence that polymyxins enter the cell and precipitate cytoplasmic components, primarily ribosomes.

Maintenance dose : 9 MIU/day in 2-3 divided doses. In patients who are critically ill, a loading dose of 9 MIU should be administered. Renal impairment patients : Dose adjustments in renal impairment patients are necessary. Dose reductions are recommended for patients with creatinine clearance < 50 ml/min. Twice daily dosing is recommended.

• Creatinine clearance <50-30 ml/min: daily dose 5.5-7.5 MIU
• Creatinine clearance <30-10 ml/min: daily dose 4.5-5.5 MIU
• Creatinine clearance <10 ml/min: daily dose 3.5 MIU
• Haemodialysis (HD) patients:

No-HD days: 2.25 MIU/day (2.2-2.3 MIU/day).

HD days: 3 MIU/day (Should be given after the HD session) Twice daily dosing is recommended.

Pediatric population : The dose should be based on lean body weight.

Children ≤40 kg: 75,000-150,000 IU/kg/day divided into 3 doses.

Children >40 kg: >150,000 IU/kg/day has been reported in children with cystic fibrosis.

Hepatic impairment patients : There are no data in patients with hepatic impairment. Caution is advised when administering colistimethate sodium in these patients.

Xylistin should not be given with certain antibiotics like- aminoglycosides and polymyxin due to report of interfere with the nerve transmission at the neuromuscular junction. It should not be given with muscle relaxants e.g., tubocurarine and other drugs including ether, succinylcholine, gallamine, decamethonium and sodium citrate. The concomitant use of Sodium Cephalothin and Xylistin should be avoided.

The use of Colistimethate Sodium Parenteral is contraindicated for patients with a history of sensitivity to the drug or any of its components.

The following adverse reactions have been reported: gastrointestinal upset, tingling of extremities and tongue, slurred speech, dizziness, vertigo and paresthesia, generalized itching, urticaria and rash, fever, increased blood urea nitrogen (BUN), elevated creatinine and decreased creatinine clearance, respiratory distress and apnea, nephrotoxicity and decreased urine output.

There are no adequate and well-controlled studies about the use of Colistimethate in pregnant women. Since colistimethate is transferred across the placental barrier in humans, it should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It is not known whether Colistimethate is excreted in human breast milk. Therefore, caution should be exercised when administered to nursing women.

Xylistin should be used with caution in patient with impaired renal function. When actual renal impairment is present, Xylistin may be used, but the greatest caution should be exercised and the dosage should be reduced in proportion to the extent of the impairment. Xylistin should be used with caution in neonates, infants and children.

Overdosage with Xylistin can cause neuromuscular blockade characterized by paresthesia, lethargy, confusion, dizziness, ataxia, nystagmus, disorders of speech and apnea. Respiratory muscle paralysis may lead to apnea, respiratory arrest and death. Overdosage with the drug can also cause acute renal failure, manifested as decreased urine output and increases in serum concentrations of B.U.N and creatinine. As in any case of overdose, Xylistin therapy should be discontinued and general supportive measures should be utilized.

Before reconstitution: Store below 30°C. After reconstitution: Store at 2°C to 8°C (Do not freeze) and use within 24 hours.