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Myasthenic Reaction to Colistimethate

Gerald N. Gold, MD; Arthur P. Richardson Jr., MD
JAMA. 1965;194(10):1151-1152. doi:10.1001/jama.1965.03090230119045.
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To the Editor:—  After reading the article by Parisi and Kaplan (194: 298,1965) describing apnea, muscle weakness, and ptosis in association with colistimethate therapy, we feel obligated to caution physicians that neuromuscular effects due to this drug may be quite common. We recently saw a patient who repeatedly developed episodes of ptosis and profound muscular weakness of the extremities in response to small doses (75 mg every 12 hours) of sodium colistimethate. Her renal function was normal, and the maximum blood level of the drug was 2μgm/ml. This value is within or below the recommended therapeutic range. Edrophonium, 10 mg, administered intravenously improved her extremity weakness, but had no effect on her facial weakness. Fortunately, toxicity due to the colistimethate was considered, and she became asymptomatic when the antibiotic was discontinued. It is conceivable that had this patient received the customary dose of the drug (300 mg), or had there


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