- International consensus recommendations regarding polymyxins (including polymyxin B and colistin) for last-resort treatment of deadly, drug-resistant bacteria are now available.
Why this matters
- Consult recommendations for selection, maximum dosage, treatment strategies, best practice when combining polymyxins with other antibiotics.
- Polymyxin B is preferred for routine systemic use in invasive infections.
- Colistin is preferred for lower urinary tract infections, delivery to the heart, brain, spinal cord.
- Colistin is administered intravenously (IV) as inactive prodrug colistin methanesulfonate (CMS); for reference, 1 million IU corresponds to ~33 mg CBA (colistin base activity) and to ~80 mg chemical CMS. (Note if reported milligram doses are CBA [preferred] or chemical [avoid] CMS.)
- Avoid agents associated with acute kidney injury during polymyxin therapy.
- Use polymyxins in combination with ≥1 antibiotic (based on susceptibility) in patients with superbugs carbapenem-resistant (CR) Pneumoniae aeruginosa, CR Enterobacteriaceae.
- For CR Acinetobacter baumannii, use polymyxins in combination with only an antibiotic to which bacteria are susceptible or alone if no such drug is available.