Abstract
Polymyxins were used for the management of gram-negative infections in clinical practice science1940s. Parenteral administration waned in the seventies owing to polymyxins nephrotoxicity and neurotoxicity. Because of the lack of treatment choices for MDR and/or XDRgram negative superbugs as well as Acinetobacter baumannii, Klebsiella pneumonia, and Pseudomonas aeruginosa, there is a growing need for effective prescribing of old antibiotics that are still effective. However, understanding of polymyxins pharmacokinetics (PK) was restricted and clinical experience is limited which leads to a lack of widespread availability of up-to-date dosing guidelines that could potentially result in the incorrect use of these “last resort” antibiotics. Recently, polymyxin B resistant strains are also a reason of concern. In this review, we discuss the importance of preserving the effectiveness of polymyxins for nosocomial gram-negative infections and strategies to improve polymyxins’ prescription. We recommend that polymyxins should only be used to manage significant MDR and/or XDRgram-negative infections, in optimum doses and if possible, in combination therapy
Highlights
Microbial resistance to antibiotics has a growing interest as it represents a vital issue for public health (Ventola, 2015; Hooton & Levy 2001)
Studies of polymyxin B based on the time-kill against different isolates of P. aeruginosa, K. pneumoniae, and A. baumannii showed concentration-dependent killing
With a breakpoint of ≤ 2 mg/L, 98.2% of strains were identified to be susceptible. These findings proved the efficacy of polymyxin B for carbapenem-resistant A. baumannii (CRAB) infections
Summary
Microbial resistance to antibiotics has a growing interest as it represents a vital issue for public health (Ventola, 2015; Hooton & Levy 2001). There is a growing need for effective prescribing of old antibiotics that are still effective against multidrug and extremely drug-resistant (MDR and XDR) bacteria. International collaborative efforts are called to achieve this goal. In this concern, polymyxins is one of the frontline antibiotics which have not been used widely in the previous years (Theuretzbacher et al, 2015). Because of the lack of use in the last 50 years, pharmacodynamics (PD) of polymyxins is very limited. Intravenous (iv) administration of these drugs has substantially increased in the last
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