toxylact: a07aa10 colistin

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A07AA10 comprises oral colistin (including colistin sulfate and colistimethate), a polymyxin‑class polypeptide antibiotic used as a locally acting intestinal anti‑infective; oral colistin is likely to produce very low exposure in breastfed infants because it is poorly absorbed from the maternal gastrointestinal tract, although systemic polymyxin therapy is potentially neuro‑ and nephrotoxic.atcddd.fhi+4

Drug and ATC classification

Colistin (polymyxin E) is a cyclic polypeptide antibacterial agent belonging to the polymyxin class and active mainly against Gram‑negative bacteria, particularly Pseudomonas aeruginosa.pmc.ncbi.nlm.nih+3
In the ATC system, oral colistin used as an intestinal antiinfective is classified as A07AA10 within subgroup A07AA (intestinal antibiotics), with a defined daily dose of 9 million IU orally for treatment of intestinal infections.atcddd.fhi+2
This oral intestinal colistin is considered a “reserve” antibiotic in stewardship frameworks, and has not been included on the WHO Essential Medicines List as an oral formulation.atcddd.fhi+1

Pharmacology and toxicology

Colistin acts as a cell membrane function inhibitor by binding to lipopolysaccharides and phospholipids in the outer membrane of Gram‑negative bacteria, disrupting membrane integrity and causing rapid bacterial cell death.pmc.ncbi.nlm.nih+2
When administered orally for intestinal indications, colistin is poorly absorbed from the gastrointestinal tract, so most of the dose remains within the intestinal lumen and is excreted via the feces; oral colistin is therefore unsuitable for systemic Gram‑negative infections, which require parenteral polymyxin therapy.atcddd.fhi+2
Systemic colistin or colistimethate (parenteral or inhaled) can cause dose‑related nephrotoxicity and neurotoxicity, including paresthesia, dizziness, ataxia, neuromuscular blockade and, in overdose, respiratory muscle paralysis and apnea.pmc.ncbi.nlm.nih+2

Use in lactation

Poorly absorbed intestinal antibiotics such as oral colistin typically lead to very low maternal plasma levels and, consequently, minimal transfer into breast milk.atcddd.fhi+2
Given its limited systemic absorption after oral administration, clinically relevant colistin concentrations in milk are unlikely, and oral A07AA10 colistin is generally considered compatible with breastfeeding after individualized risk–benefit assessment.who+3
Nevertheless, because systemic polymyxin therapy is potentially neuro‑ and nephrotoxic, and data in lactation are limited, close monitoring of the breastfed infant for gastrointestinal symptoms and unexpected adverse effects is prudent, particularly in preterm or medically fragile infants.who+2

Clinical considerations in breastfeeding women

Clinicians should distinguish clearly between oral intestinal colistin (A07AA10), which is minimally absorbed, and systemic colistimethate or colistin used parenterally or by inhalation, which carries significant risks of nephrotoxicity and neurotoxicity and may result in higher milk transfer.atcddd.fhi+3
When oral colistin is required in a breastfeeding mother, standard principles apply: prescribe the lowest effective dose for the shortest duration, consider maternal renal function and concomitant nephrotoxic drugs, and assess infant factors such as prematurity and comorbidities.who+3
Use of specialized lactation resources and expert consultation is recommended, as most maternal antibiotics are compatible or probably compatible with breastfeeding, but polymyxin‑class agents merit particular attention due to their systemic toxicity profile.

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