TABLE 7.
Examples of colistin bundle elements.
| Bundle element | Examples |
|---|---|
| Submit a specimen for MC&S from the suspected site of infection prior to colistin initiation (ideally from a sterile site*) | *Blood culture, *cerebrospinal fluid, urine, fluid, tissue, pus, respiratory specimens |
| Approval to use colistin | Medical microbiology or infectious diseases authorisation prior to dispensing |
| Document the clinical indication and note whether therapy was empiric or targeted | Bacteraemia, meningitis, ventilator-associated pneumonia, urinary tract infection, endocarditis, osteomyelitis |
| For patients with a positive culture, document the microbiological indication, including organism and antibiotic susceptibility | CRE, MDR/XDR A. baumannii, MDR/XDR P. aeruginosa |
| Document investigations performed to look for the source of infection | Possible sources: IV lines, endocarditis, pus collections (intra-abdominal, intracranial), urinary tract, pneumonia, prosthetic material etc. |
| Obtain consent to use the unlicensed drug | Complete the appropriate documentation |
| Consider whether renal dose adjustment is needed | Use the appropriate age and gestation related norms for creatinine and appropriate formula to calculate e-GFR. Document if renal dose adjustment is required. |
| Provide a loading dose and document the loading dose in mg/kg | - |
| Document maintenance dose in mg/kg | Hospital AMS committee should develop and circulate dosing charts to guide colistin prescribers |
| Document if combination therapy was used and which antimicrobial agent was given | - |
| De-escalation should be performed promptly based on culture results and pathogen susceptibility testing, infection source and clinical response | Document duration of therapy based on clinical indication |
| Ensure feedback documentation for SAPHRA is completed | Carefully document adverse events and deaths occurring during colistin therapy |
CRE, carbapenem-resistant Enterobacterales; XDR, extensively drug resistant; MC&S, microscopy, culture and susceptibility testing; SAPHRA, South African Health Products Regulatory Authority.