Nebulised Colomycin^® (colistimethate sodium) is used as part of eradication therapy for patients who are colonised with Pseudomonas aeruginosa (PA). Eradication course is usually 6-12 weeks.

Long-term Colomycin^® therapy is considered for patients with non-CF bronchiectasis who experience three or more PA exacerbations per year despite optimised physiotherapy and muco-active treatment.¹

Respiratory Consultant to prescribe required dose and ward pharmacist/ nursing staff to order test dose medication and refer to Physiotherapy team via EPIC and call:

(adapted from BTS guideline¹)

1. Explain the procedure to the patient and warn of possible side effects (cough, wheeze, chest tightness, breathlessness) Stop administration if these occur.

2. Ensure the patient/ a carer will be able to administer the medication (consider eye sight, dexterity, cognition etc)

3. Ensure correct dose is prescribed on drug chart (1MU or 2MU Colomycin with 3mls or 4mls 0.9% NaCl respectively)

4. Request nurses to provide and sign the MAR for the Colomycin, salbutamol (in case of bronchospasm post test dose – not for routine administration) and saline nebules.

5. Check the name, dose and expiry date of the test drug and dilutants. In the inpatient setting, this should be completed by the nurse.

6. Check for a history of allergy/ sensitivity to the drug and if the patient had a test dose previously.

7. Before starting the procedure check equipment: nebuliser compressor, ampoule access straw (Figure 1- used at KEH only), aeroeclipse nebuliser circuit set to breath actuated mode (Figure 2), filter (Figure 3), Salbutamol nebule, syringe, calibrated spirometer with suitable mouth piece and filter, appropriate staff PPE and that the patient has taken any prescribed bronchodilators.

8. Carry out standardised spirometry at baseline (x 3 forced blows, taking the best FEV₁ reading) then x 1 at 15 minutes. Record these results on the record sheet.

9. If the FEV₁ drops by <15% and <200mls and the patient does not experience side effects, it is safe to give the nebulised antibiotic.

10. If the FEV₁ drops by >15% and >200mls or if symptoms of bronchospasm occur, administer salbutamol by nebuliser. Failure to return to baseline should trigger an appropriate medical review and monitoring of observations should continue until this review has taken place. The drug is not safe to give. In the inpatient setting, please inform the medical team for clinical review.

11. If bronchospasm has occurred, discuss with consultant to possibly repeat the test on a separate day with pre nebulised salbutamol.

12. Please document via EPIC using the following smart phrase: PTTESTDOSE

13. Inform the consultant of outcome of the test dose via EPIC or letter (for KEH patients)

1. After completing Chest Clearance and usual inhaler therapy, patient washes their hands.

2. Gently tap Colomycin^® vial on hard surface to loosen the powder.

3. Flip off the plastic cap and then remove the foil seal from the vial. Remove the plastic bung from the vial.

4. Draw up the prescribed amount of 0.9% NaCl with the provided syringe and straw and add this to the Colomycin powder in the glass vial. Replace the bung and gently swirl until the fluid is clear. DO NOT SHAKE

5. Add the resulting clear solution into the nebuliser chamber. Turn on compressor and nebulise until empty.

6. Patient washes their hands and swills, gargles and spits water. Inform on cleaning and expiry of equipment.

7. Patient to repeat procedure twice a day (roughly 12 hours apart) for duration of treatment course.

• Colomycin^® should only be nebulised through an Aeroeclipse nebuliser circuit with the circuit turned to ‘breath actuated’ (dotted triangle).

• Any usually prescribed bronchodilators should be used BEFORE Colomycin^®.

• Colomycin^® should not be mixed with other medication in the nebuliser chamber.

For East Berks patients, refer to AIR Team via EPIC, or on 03006146469

For Bucks patients, refer to BIRS on 01296 566113.

For North East Hampshire, Farnham and Surrey Heath and patients, refer to Frimley Respiratory Community Team via email by sending a discharge summary or referral form to spa@nhs.net. Contact number 0300 003 0050.

• Issue patient with the Aeroeclipse, x 1 straw (KEH only), x 4 syringes and the Patient Information Leaflet.

• Refer to AIR Team or BIRS team to arrange NRS nebuliser if patient doesn’t already have one.

• Please liaise with AIR Team or Respiratory nurses at FPH prior to discharge to ensure nebuliser is in place prior to discharge.

• Consultant to order the first four weeks supply via pharmacy on EPIC, for patient to take home on d/c.

• South team (FPH)- Further prescriptions to be requested by patient through respiratory secretaries on 0300 0300 614 7919

• North team (WPH/ KEH) Remainder of supply to be ordered via Lloyds Homecare – doctor and pharmacy to complete Homecare prescription for remainder of course (usually 6-12 weeks for eradication therapy) for drugs to be delivered to patients home.

• Patient to contact community respiratory team for replacement aeroeclipse (and filter, as required) at 6 months.

• Request that the patient brings in their own nebuliser kit and Colomycin^® supply from home.

• If the patient cannot bring in own nebuliser from home patient to use ward nebuliser and be issued with an Aeroeclipse (contact Medical Respiratory Physiotherapists)

• If patient cannot bring in own supply of Colomycin^® from home contact ward pharmacist for supply.

1. Hill, A. T., et al. (2019) 'British Thoracic Society Guideline for bronchiectasis in adults', Thorax, 74, p. 1-69. Available at: http://dx.doi.org/10.1136/thoraxjnl-2018-212463 (Accessed: 03 November 2023).

2. Teva UK Limited (2020) Colomycin 1 million International Units (IU) Powder for solution for injection, infusion or inhalation. Available at: https://www.medicines.org.uk/emc/product/1094/smpc#gref (Accessed: 03 November 2023).

Figure 1: Ampoule access straw

Figure 2: Aeroeclipse nebuliser circuit set to ‘breath actuated mode’. Note- white markers are turned to the dotted triangle to enable this mode.

Figure 3: Aeroeclipse nebuliser circuit set up with filter using T-piece connector

This guideline has been registered with the Trust. However, clinical guidelines are guidelines only. The interpretation and application of clinical guidelines will remain the responsibility of the individual clinician. If in doubt, contact a senior colleague or expert. Caution is advised when using guidelines after the review date.

This guideline is for use in Frimley Health NHS Foundation Trust hospitals only. Any use outside this location will not be supported by the Trust and will be at the risk of the individual using it.

Version History

Related Documents