Guidelines for the clinical use of colistin and polymyxin B


  • Dawn O'Shea
  • Univadis Medical News
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The first ever consensus recommendations on the use of colistin (polymyxin E) and polymyxin B have been published. The guidelines are endorsed by organisations including the American College of Clinical Pharmacy, Infectious Diseases Society of America, International Society of Anti‐Infective Pharmacology and Society of Infectious Diseases Pharmacists.

Key recommendations include:

  • Polymyxin B preferred for routine systemic use in invasive infections.
  • Colistin preferred for lower urinary tract infections.
  • Recommended daily colistin dose is 300-360 mg colistin base activity in two doses infused over 0.5-1 hour at 12‐hour intervals (normal renal function).
  • A loading dose of 2.0-2.5 mg/kg over one hour is recommended for polymyxin B.
  • For severe infections, administer polymyxin B 1.25-1.5 mg/kg every 12 hours infused over one hour.
  • Polymyxin B doses should not be adjusted in patients receiving renal replacement therapy.
  • Where colistin and polymyxin B are available, polymyxin B is preferred to limit acute kidney injury.
  • For invasive carbapenem‐resistant Enterobacteriaceae, polymyxin B or colistin can be used in combination with ≥1 additional agent.
  • For invasive carbapenem‐resistant Acinetobacter baumannii, polymyxin B or colistin should be used with ≥1 agent.
  • Use adjunctive polymyxin aerosol (colistin or polymyxin B) with intravenous polymyxin for extensively drug‐resistant gram‐negative health care-associated or ventilator‐associated pneumonia.