What is colistimethate sodium?
Your doctor has advised you to take nebulised colistimethate sodium to treat an infection in your lungs called Pseudomonas aeruginosa. This treatment should reduce the amount of infection in your lungs. It aims to prevent or delay worsening of your symptoms and the need for frequent courses of antibiotics. This leaflet tells you how to prepare and use nebulised colistimethate sodium.
What is a nebuliser?
Nebulisers are machines used to turn medicines into a fine mist which can be inhaled into your lungs. This means your medicine is acting directly in your lungs at the source of the problem.
This treatment is prescribed to be taken twice a day, morning and evening. It should be taken closely after your chest clearance breathing exercises. This means your lungs are most likely to be clear of sputum which gives the colistimethate sodium its best chance of working effectively.
Your first dose of this medication will be given under supervision by the respiratory nursing team in a face to face clinic setting at the hospital. This is because colistimethate sodium can in some cases irritate the lungs and cause chest tightness. This is a trial to ensure you are suitable to use this medication long term at home safely. Please note if you become very wheezy and tight chested at home, you should stop the nebuliser immediately, take your salbutamol inhaler/nebuliser and if there is no improvement call 999 for an ambulance.
The information in this leaflet will help remind you how to set up your nebulised colistimethate sodium, so you can have treatment at home.
Equipment needed
- Colistimethate sodium 1 million unit vial or 2 million unit vial
- Sodium Chloride 0.9% ampoules
- 5 mL syringe to measure the sodium chloride 0.9%
- Nebuliser machine, tubing and Pari-Neb mouth piece
- Sterile needle to draw up the medication
- Yellow sharps bin
How to prepare colistimethate sodium?
Before you start, please note that colistimethate sodium should be nebulised in a well ventilated room without any other people or pets present where possible.
Instructions
- Wash your hands with soap and water; dry them with a clean towel.
- Assemble all necessary equipment.
- Check your colistimethate sodium vial and liquid ampoules are in date.
- Ensure your mouth piece is fitted together as you were shown (photo below), a new clean cotton filter should be used every 24 hours, and tubing connected from the mouth piece to the machine.
- Gently tap the colistimethate sodium vial on a hard surface, to loosen the powder inside.
- Remove the foil seal by carefully ripping it away from the side of the vial.
- Remove the coloured bung from the vial.
- Open the container of sodium chloride 0.9% by snapping the top off.
- Use a 5 mL syringe and draw up the appropriate volume of the sodium chloride 0.9% solution. See table below for what volume of sodium chloride 0.9% to use:
- Colistimethate 1 million unit vial: 3mLs of sodium chloride 0.9% (saline)
- Colistimethate 2 million unit vial: 4mLs of sodium chloride 0.9% (saline)
- Add the sodium chloride 0.9% to the colistimethate sodium bottle (gently press the plunger down on the syringe).
- Put the rubber bung back on and gently tip the bottle side to side to mix the liquid and powder. Continue until the powder in the colistimethate sodium bottle dissolves completely.
- Pour the contents of the colistimethate sodium bottle into the Pari-Neb pot as you were shown.
- PLEASE NOTE: If using the 2 million-unit vial to give a 1 million-unit dose, withdraw half (2 mL) of the final 4 mL prepared solution and place into the Pari-Neb pot as you were shown.
- The remainder of the solution can be kept refrigerated between 2°c – 8°c for up to 24 hours. Use the remainder of the vial for the next dose.
- Do not put the colistimethate sodium into the nebuliser chamber until just before you are going to take it, as these medications do not contain preservatives. Keep your nebuliser upright. Do not add any other medication to the chamber with the colistimethate sodium solution.
- Place the mouthpiece into your mouth, turn on your machine, and take normal steady breaths for about 10 minutes, or until all of the vapour has finished. When using your nebuliser you should sit up straight. Do not talk while you are using your nebuliser.
- Vent the air that you have breathed out outside through a tube (this will be shown to you at your appointment).
- Rinse your mouth thoroughly with water (and spit) after taking your nebulised colistimethate sodium in order to prevent a mouth infection or a sore throat developing.
- When you have finished taking your nebuliser dose follow the instructions of how should I care for my nebuliser.
Other Useful Information
Side effects of colistimethate sodium:
Sometimes nebulised colistimethate sodium can lead to unwanted side effects, such as:
- coughing
- bronchospasm (a tight feeling in your chest)
- wheezing
- a sore throat or mouth
- a hoarse voice
- nausea (feeling sick)
- a change to your sense of taste
Rarely this medicine can cause a skin rash. If you develop a rash or any of the symptoms above, please stop using colistimethate sodium and contact your GP or hospital team for further help.
How should I care for my nebuliser?
You have been given your own mouth piece and tubing. To keep your nebuliser working properly and prevent infection, the nebuliser chamber (mouth piece equipment) should be emptied after each use and washed in warm water with a little washing up liquid, then rinsed with clear water. Leave to dry naturally on a clean towel or kitchen roll.
Once a week you should boil the Pari-Neb nebuliser chamber in a pan of water, with 2 – 3 drops of washing up liquid added, for 6 – 10 minutes, then rinse with clear water. Alternatively you can make up a sterilisation solution (such as Milton) and follow the manufacturer guidelines on sterilisation. The white cotton filter should be discarded every 24hours. The filter can be used twice only, and must be dried between each use.
Further Supplies
Your colistimethate sodium vials and sodium chloride 0.9% ampoules can be refilled on repeat prescription from your GP, if this is not possible then order direct from your respiratory consultant at the hospital. Cotton filters can be requested from the Respiratory Nursing team as per contact numbers below. You will need to collect these from hospital yourself. Your Pari-Neb mouth piece will last for 1 year, please contact the respiratory nurses for a replacement after that time.
Contact numbers
Adults
Bedford Respiratory Team – 01234 795859
Luton Respiratory Team – 01582 497483
Paediatrics
Bedford – 01234 355122 (Ext: 4099)
Luton – 01582 497401
Colistimethate Sodium Nebulised Medication Trial and Home Therapy (Adults and Paediatrics)
Created by: Liam Daley (Lead pharmacist, antimicrobials)
Checked by: Shilpa Jethwa (Highly Specialist Antimicrobial Pharmacist) & David Allen (Lead respiratory nurse practitioner)
Approved by DTC: May 2025