Coly-Mycin and NEC

[Tiki_Torch]

Do any of your neonatologists order Coly-Mycin (q8h x 5 days via OG tube) for babies who are have feeding intolerance and are also at high risk of having NEC?

Last night I took care of a little one who has had two rounds of Indocin for PDA and a few days ago was made NPO after having increased residuals and bowel loops seen (no frank bloody stools, etc. though). X-rays showed "some air in the bowel" but I guess not enough to have our doctors do anything more than make the baby NPO for a couple of days. After being NPO a couple of days and having a normal x-ray, the baby was restarted on og feedings of 1 ml Pedialyte og q3h for one day, then 3 ml Pregestimil q3h for a day and then increased to 6 ml q3h the next day... along with the order for Coly-Mycin.

Anyway, I've never given Coly-Mycin (Colistimethate) and could not find it in our Neofax , my Neonatal Medications & Nutrition: A Comprehensive Guide, 3rd Edition by Zenk, Sills & Koeppel (which has practically everything in it and which I absolutely adore), our adult drug books, or our Hariett Lane book. Our hospital pharmacy formulary on our hospital computer noted the name of the medication and only said something like "for use in suspected NEC cases" but gave no nursing care information... just dosages. Finally, we found some information in our good-ole PDR. I don't know about you, but I have a real problem when it comes to giving a medication without knowing the nursing indications, possible complications, administration guidelines, yada-yada.

So, back to my original question, are you familiar with giving this drug to babies at high risk of NEC as a prophylactic treatment? Is this a new treatment regimen? I've not read anything about it in my recent neonatal nursing journals... I feel like I'm out of the loop on this one...

Any input would be very much appreciated.

Thanks!

Tiki

[dawngloves, BSN, RN]

Never heard of it either.What's it's basic pharmocology?

[Tiki_Torch]

Hi DawnGloves,

It's always great to hear from you!

From what I've been able to find on the internet, it's "indicated for the treatment of acute or chronic infections due to sensitive strains of certain gram-negative bacilli. It is particularly indicated when the infection is caused by sensitive strains of Pseudomonas aeruginosa. This antibiotic is not indicated for infections due to Proteus or Neisseria. Coly-Mycin M Parenteral has proven clinically effective in treatment of infections due to the following gram-negative organisms: Enterobacter aerogenes, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa. It may be used to initiate therapy in serious infections that are suspected to be due to gram-negative organisms and in the treatment of infections due to susceptible gram-negative pathogenic bacilli."

I found this information on the website of King Pharmaceuticals, Inc., the maker of this drug (its distributed by Monarch Pharmaceuticals). (http://www.kingpharm.com) I also see lots of links to the use of this antibiotic for ear infections.

Working 11-7, I basically never see our neos in order to ask them about it... By the way, this child has no cultures of any type growing anything. I understand that there is no definately understood reason for NEC occuring but that bacterial intestinal infections have been considered possible causes... I wonder if the current neonatology literature is on to something new... I wish I could find something about this.

If anyone has any information about the use of Coly-Mycin for prophylactic treatment of NEC, please share it with us. Thanks bunches!