Polymyxins: international expert panel issues guidelines for optimal use

  • Tsuji BT & al.
  • Pharmacotherapy
  • 1 Jan 2019

  • International Clinical Digest
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Takeaway

  • 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.

Key highlights

  • 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.

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